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GREAT BOOKS 
OF THE WESTERN WORLD 

ROBERT MAYNARD HUTCHINS, EDITOR IN CHIEF 



10. 

HIPPOCRATES 
GALEN 



MORTIMER J. ADLER, Associate Editor 

Members of the Advisory Board: STRINGFELLOW BARR, SCOTT BUCHANAN, JOHN ERSKINB, 

CLARENCE H. FAUST, ALEXANDER MEIKLEJOHN, JOSEPH J. SCHWAB, MARK VAN DOREN. 

Editorial Consultants: A. F. B. CLARK, F.L LUCAS, WALTER MURDOCH. 

WALLACE BROCKWAY, Executive Editor 



HIPPOCRATIC WRITINGS 



ON 

THE NATURAL FACULTIES 

BY GALEN 




WILLIAM BENTON, Publisher 

ENCYCLOPEDIA BRITANNICA, INC. 

CHICAGO LONDON < TORONTO 



The text of On the Natural Faculties, translated 

by Arthur John Brock, M.D., is reprinted by arrangement with the 

HARVARD UNIVERSITY PRESS. 



COPYRIGHT IN THE UNITED STATES OF AMERICA, 1952, 
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COPYRIGHT 1952. COPYRIGHT UNDER INTERNATIONAL COPYRIGHT UNION BY 

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GENERAL CONTENTS 



HIPPOCRATIC WRITINGS, Page i 

Translated b? FRANCIS ADAMS 



ON THE NATURAL FACULTIES, Page 167 

BY GALEN 
Translated by ARTHUR JOHN BROCK, M. D. 



HIPPOCRATIC WRITINGS 



BIOGRAPHICAL NOTE 
HIPPOCRATES, //. 40x5 B.C. 



OUR knowledge of the historical Hippocrates 
is almost completely dependent upon Plato. 
From the Protagoras and the Phcedrus we 
learn that Hippocrates was a contemporary of 
Socrates, that he was a native of Cos, and an 
Asclepiad, a member, that is, of a family or 
guild that traced its origin to the God of 
Healing. He was well known both as a prac- 
titioner and a teacher of medicine, and he held 
that knowledge of the body depends upon the 
knowledge of the whole man. There is also 
the implication in Plato's words that Hippoc- 
rates travelled from city to city and that, like 
the great sophists and rhetoricians, he came to 
Athens to practise and to teach his art. 

The figure of the legendary Father of Medi- 
cine soon replaced the historical Hippocrates. 
Although there is no evidence from his own 
time that he left any writings, within a cen- 
tury medical works were being attributed to 
him, especially those emanating from the fa- 
mous medical school of Cos. The writings 
which now go by the name of the Hippocratic 
Collection consist for the most part of the early 
Greek medical treatises which were brought 
together by the Alexandrian scholars of the 



third century. The Collection is large and het- 
erogeneous and although all were attributed to 
Hippocrates, the genuineness of some of them 
was questioned even in antiquity. 

The Alexandrian accounts of the life of 
Hippocrates are rich in detail. He was born in 
the year 460 B.C., descended from Hercules as 
well as from ^Esculapius. He studied medicine 
and philosophy from famous teachers and trav- 
elled over the whole Greek world, curing a 
Macedonian tyrant of the malady of love, driv- 
ing out the plague from Athens by lighting fires 
in the public squares, refusing to go to Persia to 
treat the King, and dying at a great age the 
dates range from 375 to 351 B.C. at Larissa in 
Thessaly, where his tomb could still be seen in 
the second century, A.D. The honey of the bees 
that swarmed there was said to be healing to the 
mouth, a tribute to the man who, according to 
Celsus, was as eminent for eloquence as for 
knowledge. 

For succeeding generations Hippocrates has 
been, as he was for Galen, the legislator of 
medicine, the ideal physician "who with pu- 
rity and with holiness lived his life and prac- 
tised his art." 



IX 



Contents 



BIOGRAPHICAL NOTE ix 

THE OATH xiii 

ON ANCIENT MEDICINE i 

ON AIRS, WATERS, AND PLACES 9 

THE BOOK OF PROGNOSTICS 19 

ON REGIMEN IN ACUTE DISEASES 26 

OF THE EPIDEMICS 44 

Oi INJURIES oi< THE HEAD 63 

ON THE SURGERY 70 



ON FRACTURES 

ON THE ARTICULATIONS 

INSTRUMENTS OF REDUCTION 

APHORISMS 

THE LAW 

ON ULCERS 

ON FISTULAE 

ON HEMORRHOIDS 

ON THE SACRED DISEASE 



74 
9i 

121 

I3 1 

144 

M5 
150 

152 
154 



XI 



The Oath 

I SWEAR by Apollo the physician, and &sculapius, and Health, 
and All-heal, and all the gods and goddesses, that, according 
to my ability and judgment, I will keep this Oath and this 
stipulation to reckon him who taught me this Art equally dear 
to me as my parents, to share my substance with him, and relieve 
his necessities if required; to look upon his offspring in the same 
footing as my own brothers, and to teach them this art, if they shall 
wish to learn it, without fee or stipulation; and that by precept, 
lecture, and every other mode of instruction, I will impart a knowl- 
edge of the Art to my own sons, and those of my teachers, and 
to disciples bound by a stipulation and oath according to the 
law of medicine, but to none others. I will follow that system 
of regimen which, according to my ability and judgment, I consider 
for the benefit of my patients, and abstain from whatever is dele- 
teriotis and mischievous. I will give no deadly medicine to any one 
ij asked, nor suggest any such counsel; and in like manner I will 
not give to a woman a pessary to produce abortion. With purity and 
with holiness I will pass my life and practice my Art. I will not 
cut persons laboring under the stone, but will leave this to be done 
by men who are practitioners of this work. Into whatever houses I 
enter, I will go into them for the benefit of the sick, and will abstain 
from every voluntary act of mischief and corruption; and, further 
from the seduction of females or males, of freemen and slaves. 
Whatever, in connection with my professional practice or not, in 
connection with it, I see or hear, in the life of men, which ought not 
to be spoken of abroad, I will not divulge, as reckoning that all 
such should be kept secret. While I continue to keep this Oath un- 
violated, may it be granted to me to enjoy life and the practice of 
the art, respected by all men, in all times! But should I trespass 
and violate this Oath, may the reverse be my lot! 



HIPPOCRATIC WRITINGS 



On Ancient Medicine 



WHOEVER having undertaken to speak 
or write on Medicine, have first laid 
down for themselves some hypothesis 
to their argument, such as hot, or cold, or moist, 
or dry, or whatever else they choose (thus re- 
ducing their subject within a narrow compass, 
and supposing only one or two original causes 
of diseases or of death among mankind), are 
all clearly mistaken in much that they say; and 
this is the more reprehensible as relating to an 
art which all men avail themselves of on the 
most important occasions, and the good opera- 
tors and practitioners in which they hold in 
especial honor. For there are practitioners, some 
bad and some far otherwise, which, if there had 
been no such thing as Medicine, and if nothing 
had been investigated or found out in it, would 
not have been the case, but all would have been 
equally unskilled and ignorant of it, and every- 
thing concerning the sick would have been di- 
rected by chance. But now it is not so; for, as in 
all the other arts, those who practise them differ 
much from one another in dexterity and knowl- 
edge, so is it in like manner with Medicine. 
Wherefore I have not thought that it stood in 
need of an empty hypothesis, like those sub- 
jects which are occult and dubious, in attempt- 
ing to handle which it is necessary to use some 
hypothesis; as, for example, with regard to 
things above us and things below the earth; if 
any one should treat of these and undertake to 
declare how they are constituted, the reader or 
hearer could not find out, whether what is de- 
livered be true or false; for there is nothing 
which can be referred to in order to discover 
the truth. 

2. But all these requisites belong of old to 
Medicine, and an origin and way have been 
found out, by which many and elegant discov- 
eries have been made, during a length of time, 
and others will yet be found out, if a person 
possessed of the proper ability, and knowing 
those discoveries which have been made, should 



proceed from them to prosecute his investiga- 
tions. But whoever, rejecting and despising all 
these, attempts to pursue another course and 
form of inquiry, and says he has discovered 
anything, is deceived himself and deceives oth- 
ers, for the thing is impossible. And for what 
reason it is impossible, I will now endeavor to 
explain, by stating and showing what the art 
really is. From this it will be manifest that dis- 
coveries cannot possibly be made in any other 
way. And most especially, it appears to me, that 
whoever treats of this art should treat of things 
which are familiar to the common people. For 
of nothing else will such a one have to inquire 
or treat, but of the diseases under which the 
common people have labored, which diseases 
and the causes of their origin and departure, 
their increase and decline, illiterate persons can- 
not easily find out themselves, but still it is 
easy for them to understand these things when 
discovered and expounded by others. For it is 
nothing more than that every one is put in 
mind of what had occurred to himself. But 
whoever does not reach the capacity of the il- 
literate vulgar and fails to make them listen to 
him, misses his mark. Wherefore, then, there 
is no necessity for any hypothesis. 

3. For the art of Medicine would not have 
been invented at first, nor would it have been 
made a subject of investigation (for there would 
have been no need of it), if when men are in- 
disposed, the same food and other articles of 
regimen which they eat and drink when in 
good health were proper for them, and if no 
others were preferable to these. But now neces- 
sity itself made medicine to be sought out and 
discovered by men, since the same things when 
administered to the sick, which agreed with 
them when in good health, neither did nor do 
agree with them. But to go still further back, I 
hold that the diet and food which people in 
health now use would not have been discov- 
ered, provided it had suited with man to eat 



Hippocrates 



and drink in like manner as the ox, the horse, 
and all other animals, except man, do of the 
productions of the earth, such as fruits, weeds, 
and grass; for from such things these animals 
grow, live free of disease, and require no other 
kind of food. And, at first, I am of opinion that 
man used the same sort of food, and that the 
present articles of diet had been discovered and 
invented only after a long lapse of time, for 
when they suffered much and severely from this 
strong and brutish diet, swallowing things 
which were raw, unmixed, and possessing great 
strength, they became exposed to strong pains 
and diseases, and to early deaths. It is likely, 
indeed, that from habit they would suffer less 
from these things then than we would now, 
but still they would suffer severely even then; 
and it is likely that the greater number, and 
those who had weaker constitutions, would all 
perish; whereas the stronger would hold out 
for a longer time, as even nowadays some, in 
consequence of using strong articles of food, 
get off with little trouble, but others with much 
pain and suffering. From this necessity it ap- 
pears to me that they would search out the food 
befitting their nature, and thus discover that 
which we now use: and that from wheat, by 
macerating it, stripping it of its hull, grinding 
it all down, sifting, toasting, and baking it, they 
formed bread; and from barley they formed 
cakc(maza), performing many operations in re- 
gard to it; they boiled, they roasted, they mixed, 
they diluted those things which are strong and 
of intense qualities with weaker things, fash- 
ioning them to the nature and powers of man, 
and considering that the stronger things Na- 
ture would not be able to manage if adminis- 
tered, and that from such things pains, diseases, 
and death would arise, but such as Nature 
could manage, that from them food, growth, 
and health, would arise. To such a discovery 
and investigation what more suitable name 
could one give than that of Medicine? since it 
was discovered for the health of man, for his 
nourishment and safety, as a substitute for that 
kind of diet by which pains, diseases, and deaths 
were occasioned. 

4. And if this is not held to be an art, I do 
not object. For it is not suitable to call any one 
an artist of that which no one is ignorant of, 
but which all know from usage and necessity. 
But still the discovery is a great one, and re- 
quiring much art and investigation. Wherefore 
those who devote themselves to gymnastics and 
training, are always making some new dis- 
covery, by pursuing the same line of inquiry, 



where, by eating and drinking certain things, 
they are improved and grow stronger than they 
were. 

5. Let us inquire then regarding what is ad- 
mitted to be Medicine; namely, that which was 
invented for the sake of the sick, which pos- 
sesses a name and practitioners, whether it also 
seeks to accomplish the same objects, and 
whence it derived its origin. To me, then, it ap- 
pears, as I said at the commencement, that no- 
body would have sought for medicine at all, 
provided the same kinds of diet had suited with 
men in sickness as in good health. Wherefore, 
even yet, such races of men as make no use of 
medicine, namely, barbarians, and even certain 
of the Greeks, live in the same way when sick 
as when in health; that is to say, they take what 
suits their appetite, and neither abstain from, 
nor restrict themselves in anything for which 
they have a desire. But those who have culti- 
vated and invented medicine, having the same 
object in view as those of whom I formerly 
spoke, in the first place, I suppose, diminished 
the quantity of the articles of food which they 
used, and this alone would be sufficient for cer- 
tain of the sick, and be manifestly beneficial to 
them, although not to all, for there would be 
some so affected as not to be able to manage 
even small quantities of their usual food, and 
as such persons would seem to require some- 
thing weaker, they invented soups, by mixing 
a few strong things with much water, and thus 
abstracting that which was strong in them by 
dilution and boiling. But such as could not 
manage even soups, laid them aside, and had 
recourse to drinks, and so regulated them as to 
mixture and quantity, that they were admin- 
istered neither stronger nor weaker than what 
was required. 

6. But this ought to be well known, that 
soups do not agree with certain persons in their 
diseases, but, on the contrary, when adminis- 
tered both the fevers and the pains are exacer- 
bated, and it becomes obvious that what was 
given has proved food and increase to the dis- 
ease, but a wasting and weakness to the body. 
But whatever persons so affected partook of sol- 
id food, or cake, or bread, even in small quan- 
tity, would be ten times and more decidedly 
injured than those who had taken soups, for no 
other reason than from the strength of the food 
in reference to the affection; and to whomso- 
ever it is proper to take soups and not eat solid 
food, such a one will be much more injured if 
he eat much than if he cat little, but even little 
food will be injurious to him. But all the causes 



On Ancient Medicine 



of the sufferance refer themselves to this rule, 
that the strongest things mostcspecially and de- 
cidedly hurt man, whether in health or in dis- 
ease. 

7. What other object, then, had he in view 
who is called a physician, and is admitted to be 
a practitioner of the art, who found out the 
regimen and diet befitting the sick, than he 
who originally found out and prepared for all 
mankind that kind of food which we all now 
use, in place of the former savage and brutish 
mode of living? To me it appears that the 
mode is the same, and the discovery of a simi- 
lar nature. The one sought to abstract those 
things which the constitution of man cannot 
digest, because of their wildness and intemper- 
ature, and the other those things which are be- 
yond the powers of the affection in which any 
one may happen to be laid up. Now, how does 
the one differ from the other, except that the 
latter admits of greater variety, and requires 
more application, whereas the former was the 
commencement of the process? 

8. And if one would compare the diet of 
sick persons with that of persons in health, he 
will find it not more injurious than that of 
healthy persons in comparison with that of wild 
beasts and of other animals. For, suppose a man 
laboring under one of those diseases which are 
neither serious and unsupportable, nor yet al- 
together mild, but such as that, upon making 
any mistake in diet, it will become apparent, as 
if he should eat bread and flesh, or any other of 
those articles which prove beneficial to healthy 
persons, and that, too, not in great quantity, but 
much less than he could have taken when in 
good health; and that another man in good 
health, having a constitution neither very feeble, 
nor yet strong, eats of those things which are 
wholesome and strengthening to an ox or a 
horse, such as vetches, barley, and the like, and 
that, too, not in great quantity, but much less 
than he could take; the healthy person who did 
so would be subjected to no less disturbance 
and danger than the sick person who took bread 
or cake unseasonably. All these things are proofs 
that Medicine is to be prosecuted and discov- 
ered by the same method as the other. 

9. And if it were simply, as is laid down, that 
such things as are stronger prove injurious, but 
such as are weaker prove beneficial and nour- 
ishing, both to sick and healthy persons, it were 
an easy matter, for then the safest rule would 
be to circumscribe the diet to the lowest point. 
But then it is no less mistake, nor one that in- 
jures a man less, provided a deficient diet, or one 



consisting of weaker things than what are prop- 
er, be administered. For, in the constitution of 
man, abstinence may enervate, weaken, and kill. 
And there are many other ills, different from 
those of repletion, but no less dreadful, arising 
from deficiency of food; wherefore the practice 
in those cases is more varied, and requires great- 
er accuracy. For one must aim at attaining a cer- 
tain measure, and yet this measure admits nei- 
ther weight nor calculation of any kind, by 
which it may be accurately determined, unless it 
be the sensation of the body; wherefore it is a 
task to learn this accurately, so as not to commit 
small blunders either on the one side or the 
other, and in fact I would give great praise to 
the physician whose mistakes are small, for per- 
fect accuracy is seldom to be seen, since many 
physicians seem to me to be in the same plight 
as bad pilots, who, if they commit mistakes while 
conducting the ship in a calm do not expose 
themselves, but when a storm and violent hurri- 
cane overtake them, they then, from their igno- 
rance and mistakes, are discovered to be what 
they are, by all men, namely, in losing their ship. 
And thus bad and commonplace physicians, 
when they treat men who have no serious ill- 
ness, in which case one may commit great mis- 
takes without producing any formidable mis- 
chief (and such complaints occur much more 
frequently to men than dangerous ones): un- 
der these circumstances, when they commit mis- 
takes, they do not expose themselves to ordi- 
nary men; but when they fall in with a great, a 
strong, and a dangerous disease, then their mis- 
takes and want of skill are made apparent to 
all. Their punishment is not far off, but is swift 
in overtaking both the one and the other. 

10. And that no less mischief happens to a 
man from unseasonable depletion than from re- 
pletion, may be clearly seen upon reverting to 
the consideration of persons in health. For, to 
some, with whom it agrees to take only one 
meal in the day, and they have arranged it so 
accordingly; whilst others, for the same reason, 
also take dinner, and this they do because they 
find it good for them, and not like those per- 
sons who, for pleasure or from any casual cir- 
cumstance, adopt the one or the other custom: 
and to the bulk of mankind it is of little con- 
sequence which of these rules they observe, 
that is to say, whether they make it a practice 
to take one or two meals. But there are certain 
persons who cannot readily change their diet 
with impunity; and if they make any altera- 
tion in it for one day, or even for a part of a 
day, are greatly injured thereby. Such persons, 



Hippocrates 



provided they take dinner when it is not their 
wont, immediately become heavy and inactive, 
both in body and mind, and are weighed down 
with yawning, slumbering, and thirst; and if 
they take supper in addition, they are seized 
with flatulence, tormina, and diarrhea, and to 
many this has been the commencement of a 
serious disease, when they have merely taken 
twice in a day the same food which they have 
been in the custom of taking once. And thus, 
also, if one who has been accustomed to dine, 
and this rule agrees with him, should not dine 
at the accustomed hour, he will straightway 
feel great loss of strength, trembling, and want 
of spirits, the eyes of such a person will be- 
come more pallid, his urine thick and hot, his 
mouth bitter; his bowels will seem, as it were, 
to hang loose; he will suffer from vertigo, low- 
ness of spirit, and inactivity, such are the ef- 
fects; and if he should attempt to take at sup- 
per the same food which he was wont to par- 
take of at dinner, it will appear insipid, and he 
will not be able to take it off; and these things, 
passing downwards with tormina and rum- 
bling, burn up his bowels; he experiences in- 
somnolency or troubled and disturbed dreams; 
and to many of them these symptoms are the 
commencement of some disease. 

11. But let us inquire what are the causes of 
these things which happened to them. To him, 
then, who was accustomed to take only one 
meal in the day, they happened because he did 
not wait the proper time, until his bowels had 
completely derived benefit from and had di- 
gested the articles taken at the preceding meal, 
and until his belly had become soft, and got 
into a state of rest, but he gave it a new supply 
while in a state of heat and fermentation, for 
such bellies digest much more slowly, and re- 
quire more rest and ease. And as to him who 
had been accustomed to dinner, since, as soon 
as the body required food, and when the former 
meal was consumed, and he wanted refresh- 
ment, no new supply was furnished to it, he 
wastes and is consumed from want of food. 
For all the symptoms which I describe as be- 
falling to this man I refer to want of food. And 
I also say that all men who, when in a state of 
health, remain for two or three days without 
food, experience the same unpleasant symp- 
toms as those which I described in the case of 
him who had omitted to take dinner. 

12. Wherefore, I say, that such constitutions 
as suffer quickly and strongly from errors in 
diet, are weaker than others that do not; and 
that a weak person is in a state very nearly ap- 



proaching to one in disease; but a person in 
disease is the weaker, and it is, therefore, more 
likely that he should suffer if he encounters 
anything that is unseasonable. It is difficult, see- 
ing that there is no such accuracy in the Art, to 
hit always upon what is most expedient, and 
yet many cases occur in medicine which would 
require this accuracy, as we shall explain. But 
on that account, I say, we ought not to reject 
the ancient Art, as if it were not, and had not 
been properly founded, because it did not at- 
tain accuracy in all things, but rather, since it 
is capable of reaching to the greatest exactitude 
by reasoning, to receive it and admire its dis- 
coveries, made from a state of great ignorance, 
and as having been well and properly made, 
and not from chance. 

13. But I wish the discourse to revert to the 
new method of those who prosecute their in- 
quiries in the Art by hypothesis. For if hot, or 
cold, or moist, or dry, be that which proves in- 
jurious to man, and if the person who would 
treat him properly must apply cold to the hot, 
hot to the cold, moist to the dry, and dry to the 
moist let me be presented with a man, not in- 
deed one of a strong constitution, but one of 
the weaker, and let him eat wheat, such as it is 
supplied from the thrashing-floor, raw and un- 
prepared, with raw meat, and let him drink 
water. By using such a diet I know that he will 
suffer much and severely, for he will experience 
pains, his body will become weak, and his bow- 
els deranged, and he will not subsist long. 
What remedy, then, is to be provided for one 
so situated? Hot? or cold? or moist? or dry? 
For it is clear that it must be one or other of 
these. For, according to this principle, if it is 
one of the which is injuring the patient, it is to 
be removed by its contrary. But the surest and 
most obvious remedy is to change the diet 
which the person used, and instead of wheat to 
give bread, and instead of raw flesh, boiled, and 
to drink wine in addition to these; for by mak- 
ing these changes it is impossible but that he 
must get better, unless completely disorganized 
by time and diet. What, then, shall we say? 
whether that, as he suffered from cold, these 
hot things being applied were of use to him, or 
the contrary? I should think this question must 
prove a puzzler to whomsoever it is put. For 
whether did he who prepared bread out of 
wheat remove the hot, the cold, the moist, or 
the dry principle in it? for the bread is con- 
signed both to fire and to water, and is wrought 
with many things, each of which has its pecul- 
iar property and nature, some of which it loses, 



On Ancient Medicine 



5 



and with others it is diluted and mixed. 

14. And this I know, moreover, that to the 
human body it makes a great difference wheth- 
er the bread be fine or coarse; of wheat with or 
without the hull, whether mixed with much or 
little water, strongly wrought or scarcely at all, 
baked or raw and a multitude of similar dif- 
ferences; and so, in like manner, with the cake 
(maza) ; the powers of each, too, are great, and 
the one nowise like the other. Whoever pays 
no attention to these things, or, paying atten- 
tion, does not comprehend them, how can he 
understand the diseases which befall a man? 
For, by every one of these things, a man is af- 
fected and changed this way or that, and the 
whole of his life is subjected to them, whether 
in health, convalescence, or disease. Nothing 
else, then, can be more important or more nec- 
essary to know than these things. So that the 
first inventors, pursuing their investigations 
properly, and by a suitable train of reasoning, 
according to the nature of man, made their dis- 
coveries, and thought the Art worthy of being 
ascribed to a god, as is the established belief. 
For they did not suppose that the dry or the 
moist, the hot or the cold, or any of these are 
either injurious to man, or that man stands in 
need of them, but whatever in each was strong, 
and more than a match for a man's constitu- 
tion, whatever he could not manage, that they 
held to be hurtful, and sought to remove. Now, 
of the sweet, the strongest is that which is in- 
tensely sweet; of the bitter, that which is in- 
tensely bitter; of the acid, that which is intense- 
ly acid; and of all things that which is extreme, 
for these things they saw both existing in man, 
and proving injurious to him. For there is in 
man the bitter and the salt, the sweet and the 
acid, the sour and the insipid, and a multitude 
of other things having all sorts of powers both 
as regards quantity and strength. These, when 
all mixed and mingled up with one another, 
are not apparent, neither do they hurt a man; 
but when any of them is separate, and stands 
by itself, then it becomes perceptible, and hurts 
a man. And thus, of articles of food, those 
which are unsuitable and hurtful to man when 
administered, every one is either bitter, or in- 
tensely so, or saltish or acid, or something else 
intense and strong, and therefore we are dis- 
ordered by them in like manner as we are by 
the secretions in the body. But all those things 
which a man eats and drinks are devoid of any 
such intense and well-marked quality, such as 
bread, cake, and many other things of a similar 
nature which man is accustomed to use for 



food, with the exception of condiments and 
confectionaries, which are made to gratify the 
palate and for luxury. And from those things, 
when received into the body abundantly, there 
is no disorder nor dissolution of the powers be- 
longing to the body; but strength, growth, and 
nourishment result from them, and this for no 
other reason than because they are well mixed, 
have nothing in them of an immoderate char- 
acter, nor anything strong, but the whole forms 
one simple and not strong substance. 

15. I cannot think in what manner they who 
advance this doctrine, and transfer the Art from 
the cause I have described to hypothesis, will 
cure men according to the principle which they 
have laid down. For, as far as I know, neither 
the hot nor the cold, nor the dry, nor the moist, 
has ever been found unmixed with any other 
quality; but I suppose they use the same articles 
of meat and drink as all we other men do. But 
to this substance they give the attribute of being 
hot, to that cold, to that dry, and to that moist. 
Since it would be absurd to advise the patient to 
take something hot, for he would straightway 
ask what it is? so that he must either play the 
fool, or have recourse to some one of the well- 
known substances; and if this hot thing happen 
to be sour, and that hot thing insipid, and this 
hot thing has the power of raising a disturbance 
in the body (and there are many other kinds of 
heat, possessing many opposite powers), he will 
be obliged to administer some one of them, ei- 
ther the hot and the sour, or the hot and the in- 
sipid, or that which, at the same time, is cold 
and sour (for there is such a substance), or the 
cold and the insipid. For, as I think, the very 
opposite effects will result from either of these, 
not only in man, but also in a bladder, a vessel 
of wood, and in many other things possessed of 
far less sensibility than man; for it is not the 
heat which is possessed of great efficacy, but the 
sour and the insipid, and other qualities as de- 
scribed by me, both in man and out of man, 
and that whether eaten or drunk, rubbed in ex- 
ternally, and otherwise applied. 

1 6. But I think that of all the qualities heat 
and cold exercise the least operation in the 
body, for these reasons: as long time as hot and 
cold are mixed up with one another they do not 
give trouble, for the cold is attempered and 
rendered more moderate by the hot, and the 
hot by the cold; but when the one is wholly 
separate from the other, then it gives pain; and 
at that season when cold is applied it creates 
some pain to a man, but quickly, for that very 
reason, heat spontaneously arises in him with- 



out requiring any aid or preparation. And these 
things operate thus both upon men in health 
and in disease. For example, if a person in 
health wishes to cool his body during winter, 
and bathes either in cold water or in any other 
way, the more he does this, unless his body be 
fairly congealed, when he resumes his clothes 
and comes into a place of shelter, his body be- 
comes more heated than before. And thus, too, 
if a person wish to be warmed thoroughly 
cither by means of a hot bath or strong fire, and 
straightway having the same clothing on, takes 
up his abode again in the place he was in when 
he became congealed, he will appear much 
colder, and more disposed to chills than before. 
And if a person fan himself on account of a 
suffocating heat, and having procured refriger- 
ation for himself in this manner, cease doing 
so, the heat and suffocation will be ten times 
greater in his case than in that of a person who 
docs nothing of the kind. And, to give a more 
striking example, persons travelling in the 
snow, or otherwise in rigorous weather, and 
contracting great cold in their feet, their hands, 
or their head, what do they not suffer from in- 
flammation and tingling when they put on 
warm clothing and get into a hot place? In 
some instances, blisters arise as if from burning 
with fire, and they do not suffer from any of 
those unpleasant symptoms until they become 
heated. So readily does either of these pass into 
the other; and I could mention many other ex- 
amples. And with regard to the sick, is it not 
in those who experience a rigor that the most 
acute fever is apt to break out? And yet not so 
strongly neither, but that it ceases in a short 
time, and, for the most part, without having oc- 
casioned much mischief; and while it remains, 
it is hot, and passing over the whole body, ends 
for the most part in the feet, where the chills 
and cold were most intense and lasted longest; 
and, when sweat supervenes, and the fever 
passes off, the patient is much colder than if he 
had not taken the fever at all. Why then should 
that which so quickly passes into the opposite 
extreme, and loses its own powers spontane- 
ously, be reckoned a mighty and serious affair? 
And what necessity is there for any great rem- 
edy for it? 

17. One might here say but persons in ar- 
dent fevers, pneumonia, and other formidable 
diseases, do not quickly get rid of the heat, nor 
experience these rapid alterations of heat and 
cold. And I reckon this very circumstance the 
strongest proof that it is not from heat simply 
that men get into the febrile state, neither is it 



Hippocrates 

the sole cause of the mischief, but that this 
species of heat is bitter, and that acid, and the 
other saltish, and many other varieties; and 
again there is cold combined with other quali- 
ties. These are what proves injurious; heat, it 
is true, is present also, possessed of strength as 
being that which conducts, is exacerbated and 
increased along with the other, but has no pow- 
er greater than what is peculiar to itself. 

1 8. With regard to these symptoms, in the 
first place those are most obvious of which we 
have all often had experience. Thus, then, in 
such of us as have a coryza and defluxion from 
the nostrils, this discharge is much more acrid 
than that which formerly was formed in and 
ran from them daily; and it occasions swelling 
of the nose, and it inflames, being of a hot and 
extremely ardent nature, as you may know, if 
you apply your hand to the place; and, if the 
disease remains long, the part becomes ulcer- 
ated although destitute of flesh and hard; and 
the heat in the nose ceases, not when the deflux- 
ion takes place and the inflammation is present, 
but when the running becomes thicker and less 
acrid, and more mixed with the former secre- 
tion, then it is that the heat ceases. But in all 
those cases in which this decidedly proceeds 
from cold alone, without the concourse of any 
other quality, there is a change from cold to 
hot, and from hot to cold, and these quickly 
supervene, and require no coction. But all the 
others being connected, as I have said, with 
acrimony and intemperance of humors, pass off 
in this way by being mixed and concocted. 

19. But such defluxions as are determined 
to the eyes being possessed of strong and varied 
acrimonies, ulcerate the eyelids, and in some 
cases corrode the cheeks and parts below the eyes 
upon which they flow, and even occasion rupture 
and erosion of the tunic which surrounds the 
eyeball. But pain, heat, and extreme burning 
prevail until the defluxions are concocted and 
become thicker, and concretions form about the 
eyes, and the coction takes place from the fluids 
being mixed up, diluted, and digested together. 
And in defluxions upon the throat, from which 
are formed hoarseness, cynanche, erysipelas, and 
pneumonia, all these have at first saltish, wa- 
tery, and acrid discharges, and with these the 
diseases gain strength. But when the discharges 
become thicker, more concocted, and are freed 
from all acrimony, then, indeed, the fevers pass 
away, and the other symptoms which annoyed 
the patient; for we must account those things 
the cause of each complaint, which, being pres- 
ent in a certain fashion, the complaint exists, 



On Ancient Medicine 



but it ceases when they change to another com- 
bination. But those which originate from pure 
heat or cold, and do not participate in any other 
quality, will then cease when they undergo a 
change from cold to hot, and from hot to cold; 
and they change in the manner I have described 
before. Wherefore, all the other complaints to 
which man is subject arise from powers (qual- 
ities?). Thus, when there is an overflow of 
the bitter principle, which we call yellow bile, 
what anxiety, burning heat, and loss of strength 
prevail! but if relieved from it, either by being 
purged spontaneously, or by means of a medi- 
cine seasonably administered, the patient is de- 
cidedly relieved of the pains and heat; but 
while these things float on the stomach, uncon- 
cocted and undigested, no contrivance could 
make the pains and fever cease; and when there 
are acidities of an acrid and aeruginous character, 
what varieties of frenzy, gnawing pains in the 
bowels and chest, and inquietude, prevail! and 
these do not cease until the acidities be purged 
away, or are calmed down and mixed with 
other fluids. The coction, change, attenuation, 
and thickening into the form of humors, take 
place through many and various forms; there- 
fore the crises and calculations of time are of 
great importance in such matters; but to all 
such changes hot and cold are but little exposed, 
for these are neither liable to putrefaction nor 
thickeningl^What then shall we say of the 
change? that it is a combination (crasis) of these 
humors having different powers toward one 
another. But the hot does not loose its heat when 
mixed with any other thing except the cold; 
nor again, the cold, except when mixed with 
the hot. But all other things connected with 
man become the more mild and better in pro- 
portion as they are mixed with the more things 
besides. But a man is in the best possible state 
when they arc concocted and at rest, exhibiting 
no one peculiar quality; but I think I have said 
enough in explanation of them. 

20. Certain sophists and physicians say that 
it is not possible for any one to know medicine 
who does not know what man is [and how he 
was made and how constructed], and that who- 
ever would cure men properly, must learn this 
in the first place. But this saying rather apper- 
tains to philosophy, as Empedocles and certain 
others have described what man in his origin 
is, and how he first was made and constructed. 
But I think whatever such has been said or 
written by sophist or physician concerning na- 
ture has less connection with the art of medi- 
cine than with the art of painting. And I think 



that one cannot know anything certain respect- 
ing nature from any other quarter than from 
medicine; and that this knowledge is to be at- 
tained when one comprehends the whole sub- 
ject of medicine properly, but not until then; 
and I say that this history shows what man is, 
by what causes he was made, and other things 
accurately. Wherefore it appears to me neces- 
sary to every physician to be skilled in nature, 
and strive to know, if he would wish to per- 
form his duties, whatlnan is in relation to the 
articles of food and drink, and to his other oc- 
cupations, and what are the effects of each of 
them to every one. And it is not enough to 
know simply that cheese is a bad article of 
food, as disagreeing with whoever eats of it to 
satiety, but what sort of disturbance it creates, 
and wherefore, and with what principle in man 
it disagrees; for there are many other articles 
of food and drink naturally bad which affect 
man in a different manner. Thus, to illustrate 
my meaning by an example, undiluted wine 
drunk in large quantity renders a man feeble; 
and everybody seeing this knows that such is 
the power of wine, and the cause thereof; and 
we know, moreover, on what parts of a man's 
body it principally exerts its action; and I wish 
the same certainty to appear in other cases. For 
cheese (since we used it as an example) does 
not prove equally injurious to all men, for there 
are some who can take it to satiety without be- 
ing hurt by it in the least, but, on the contrary, 
it is wonderful what strength it imparts to 
those it agrees with; but there are some who do 
not bear it well, their constitutions arc differ- 
ent, and they differ in this respect, that what 
in their body is incompatible with cheese, is 
roused and put in commotion by such a thing; 
and those in whose bodies such a humor hap- 
pens to prevail in greater quantity and inten- 
sity, are likely to suffer the more from it. But 
if the thing had been pernicious to the whole na- 
ture of man, it would have hurt all. Whoever 
knows these things will not suffer from it. 

21. During convalescence from diseases, and 
also in protracted diseases, many disorders oc- 
cur, some spontaneously, and some from certain 
things accidentally administered. I know that 
the common herd of physicians, like the vulgar, 
if there happen to have been any innovation 
made about that day, such as the bath being 
used, a walk taken, or any unusual food eaten, 
all which were better done than otherwise, at- 
tribute notwithstanding the cause of these dis- 
orders, to some of these things, being ignorant 
of the true cause but proscribing what may have 



8 Hippocrates 

been very proper. Now this ought not to be so; 
but one should know the effects of a bath or 
a walk unseasonably applied; for thus there 
will never be any mischief from these things, 
nor from any other thing, nor from repletion, 
nor from such and such an article of food. 
Whoever does not know what effect these 
things produce upon a man, cannot know the 
consequences which result from them, nor how 
to apply them. 

22. And it appears to me that one ought also 
to know what diseases arise in man from the 
powers, and what from the structures. What do 
I mean by this? By powers, I mean intense and 
strong juices; and by structures, whatever con- 
formations there are in manj For some are hol- 
low, and from broad contracted into narrow; 
some expanded, some hard and round, some 
broad and suspended, some stretched, some 
long, some dense, some rare and succulent, 
some spongy and of loose texture. Now, then, 
which of these figures is the best calculated to 
suck to itself and attract humidity from an- 
other body? Whether what is hollow and ex- 
panded, or what is solid and round, or what is 
hollow, and from broad, gradually turning nar- 
row? I think such as from hollow and broad 
are contracted into narrow: this may be ascer- 
tained otherwise from obvious facts: thus, if you 
gape wide with the mouth you cannot draw 
in any liquid; but by protruding, contracting, 
and compressing the lips, and still more by us- 
ing a tube, you can readily draw in whatever 
you wish. And thus, too, the instruments which 
are used for cupping are broad below and gradu- 
ally become narrow, and are so constructed in 
order to suck and draw in from the fleshy parts. 
The nature and construction of the parts with- 
in a man are of a like nature; the bladder, the 
head, the uterus in woman; these parts clearly 
attract, and are always filled with a juice which 
is foreign to them. Those parts which are hol- 
low and expanded are most likely to receive any 
humidity flowing into them, but cannot attract 
it in like manner. Those parts which are solid 
and round could not attract a humidity, nor re- 
ceive it when it flows to them, for it would glide 
past, and find no place of rest on them. But spon- 
gy and rare parts, such as the spleen, the lungs, 
and the breasts, drink up especially the juices 
around them, and become hardened and en- 
larged by the accession of juices. Such things 
happen to these organs especially. For it is not 
with the spleen as with the stomach, in which 
there is a liquid, which it contains and evacu- 
ates every day; but when it (the spleen) drinks 



up and receives a fluid into itself, the hollow 
and lax parts of it are filled, even the small 
interstices; and, instead of being rare and soft, 
it becomes hard and dense, and it can neither 
digest nor discharge its contents: these things 
it suffers, owing to the nature of its structure. 
Those things which engender flatulence or tor- 
mina in the body, naturally do so in the hollow 
and broad parts of the body, such as the stom- 
ach and chest, where they produce rumbling 
noises; for when they do not fill the parts so 
as to be stationary, but have changes of place 
and movements, there must necessarily be noise 
and apparent movements from them. But such 
parts as are fleshy and soft, in these there occur 
torpor and obstructions, such as happen in 
apoplexy. But when it (the flatus?) encounters a 
broad and resisting structure, and rushes against 
such a part, and this happens when it is by na- 
ture not strong so as to be able to withstand it 
without suffering injury; nor soft and rare, so 
as to receive or yield to it, but tender, juicy, full 
of blood, and dense, like the liver, owing to its 
density and broadness, it resists and does not 
yield. But flatus, when it obtains admission, in- 
creases and becomes stronger, and rushes to- 
ward any resisting object; but owing to its ten- 
derness, and the quantity of blood which it (the 
liver) contains, it cannot be without uneasiness; 
and for these reasons the most acute and fre- 
quent pains occur in the region of it, along with 
suppurations and chronic tumors (phymata). 
These symptoms also occur in the site of the dia- 
phragm, but much less frequently; for the dia- 
phragm is a broad, expanded, and resisting sub- 
stance, of a nervous (tendinous?) and strong 
nature, and therefore less susceptible of pain; 
and yet pains and chronic abscesses do occur 
about it. 

23. There are both within and without the 
body many other kinds of structure, which dif- 
fer much from one another as to sufferings 
both in health and disease; such as whether the 
head be small or large; the neck slender or 
thick, long or short; the belly long or round; 
the chest and ribs broad or narrow; and many 
others besides, all which you ought to be ac- 
quainted with, and their differences; so that 
knowing the causes of each, you may make the 
more accurate observations. 

24. And, as has been formerly stated, one 
ought to be acquainted with the powers of 
juices, and what action each of them has upon 
man, and their alliances towards one another. 
What I say is this: if a sweet juice change to 
another kind, not from any admixture, but be- 



On Airs, Waters, and Places 



cause it has undergone a mutation within it- 
self; what does it first become? bitter? salt? 
austere? or acid? I think acid. And hence, an 
acid juice is the most improper of all things 
that can be administered in cases in which a 



sweet juice is the most proper. Thus, if one 
should succeed in his investigations of external 
things, he would be the better able always to 
select the best; for that is best which is farthest 
removed from that which is unwholesome. 



On AirSj Waters, and Places 



WHOEVER wishes to investigate medicine 
properly, should proceed thus: in the first place 
to consider the seasons of the year, and what 
effects each of them produces for they are not 
at all alike, but differ much from themselves 
in regard to their changes. Then the winds, the 
hot and the cold, especially such as are common 
to all countries, and then such as are peculiar 
to each locality. We must also consider the qual- 
ities of the waters, for as they differ from one 
another in taste and weight, so also do they dif- 
fer much in their qualities. In the same man- 
ner, when one comes into a city to which he is a 
stranger, he ought to consider its situation, how 
it lies as to the winds and the rising of the sun; 
for its influence is not the same whether it lies 
to the north or the south, to the rising or to the 
setting sun. These things one ought to consider 
most attentively, and concerning the waters 
which the inhabitants use, whether they be 
marshy and soft, or hard, and running from el- 
evated and rocky situations, and then if saltish 
and unfit for cooking; and the ground, wheth- 
er it be naked and deficient in water, or wooded 
and well watered, and whether it lies in a hol- 
low, confined situation, or is elevated and cold; 
and the mode in which the inhabitants live, 
and what are their pursuits, whether they are 
fond of drinking and eating to excess, and 
given to indolence, or are fond of exercise and 
labor, and not given to excess in eating and 
drinking. 

2. From these things he must proceed to in- 
vestigate everything else. For if one knows all 
these things well, or at least the greater part of 
them, he cannot miss knowing, when he comes 
into a strange city, either the diseases peculiar 
to the place, or the particular nature of common 
diseases, so that he will not be in doubt as to the 
treatment of the diseases, or commit mistakes, 
as is likely to be the case provided one had not 
previously considered these matters. And in 
particular, as the season and the year advances, 
he can tell what epidemic diseases will attack 
the city, cither in summer or in winter, and 
what each individual will be in danger of ex- 



periencing from the change of regimen. For 
knowing the changes of the seasons, the risings 
and settings of the stars, how each of them 
takes place, he will be able to know beforehand 
what sort of a year is going to ensue. Having 
made these investigations, and knowing before- 
hand the seasons, such a one must be acquaint- 
ed with each particular, and must succeed in 
the preservation of health, and be by no means 
unsuccessful in the practice of his art. And if it 
shall be thought that these things belong rather 
to meteorology, it will be admitted, on second 
thoughts, that astronomy contributes not a lit- 
tle, but a very great deal, indeed, to medicine. 
For with the seasons the digestive organs of 
men undergo a change. 

3. But how each of the aforementioned things 
should be investigated and explained, I will 
now declare in a clear manner. A city that is 
exposed to hot winds (these are between the 
wintry rising, and the wintry setting of the 
sun), and to which these are peculiar, but which 
is sheltered from the north winds; in such a 
city the waters will be plenteous and saltish, 
and as they run from an elevated source, they 
are necessarily hot in summer, and cold in 
winter; the heads of the inhabitants arc of a 
humid and pituitous constitution, and their 
bellies subject to frequent disorders, owing to 
the phlegm running down from the head; the 
forms of their bodies, for the most part, are 
rather flabby; they do not eat nor drink much; 
drinking wine in particular, and more espe- 
cially if carried to intoxication, is oppressive to 
them; and the following diseases are peculiar 
to the district: in the first place, the women are 
sickly and subject to excessive menstruation; 
then many are unfruitful from disease, and not 
from nature, and they have frequent miscar- 
riages; infants are subject to attacks of convul- 
sions and asthma, which they consider to be 
connected with infancy, and hold to be a sacred 
disease (epilepsy). The men are subject to at- 
tacks of dysentery, diarrhea, hepialus, 1 chronic 

1 The Hepialus is a species of intermittent fever, 
very common in warm climates. 



io Hippocrates 

fevers in winter, of epinyctis, 1 frequently, and 
of hemorrhoids about the anus. Pleurisies, 
pcripncumonies, ardent fevers, and whatever 
diseases are reckoned acute, do not often occur, 
for such diseases are not apt to prevail where 
the bowels are loose. Ophthalmies occur of a 
humid character, but not of a serious nature, 
and of short duration, unless they attack epi- 
demically from the change of the seasons. And 
when they pass their fiftieth year, defluxions 
supervening from the brain, render them para- 
lytic when exposed suddently to strokes of the 
sun, or to cold. These diseases are endemic to 
them, and, moreover, if any epidemic disease 
connected with the change of the seasons, pre- 
vail, they are also liable to it. 

4. But the following is the condition of cities 
which have the opposite exposure, namely, to 
cold winds, between the summer settings and 
the summer risings of the sun, and to which 
these winds are peculiar, and which are shel- 
tered from the south and the hot breezes. In the 
first place the waters are, for the most part, 
hard and cold. The men must necessarily be well 
braced and slender, and they must have the dis- 
charges downwards of the alimentary canal 
hard, and of difficult evacuation, while those 
upwards are more fluid, and rather bilious than 
pituitous. Their heads are sound and hard, and 
they are liable to burstings (of vessels? ) for the 
most part. The diseases which prevail epidem- 
ically with them, are pleurisies, and those which 
are called acute diseases. This must be the case 
when the bowels are bound ;and from any causes, 
many become affected with suppurations in the 
lungs, the cause of which is the tension of the 
body, and hardness of the bowels; for their dry- 
ness and the coldness of the water dispose them 
to ruptures (of vessels?). Such constitutions 
must be given to excess of eating, but not of 
drinking; for it is not possible to be gourmands 
and drunkards at the same time. Ophthalmies, 
too, at length supervene; these being of a hard 
and violent nature, and soon ending in rupture 
of the eyes; persons under thirty years of age are 
liable to severe bleedings at the nose in summer; 
attacks of epilepsy are rare but severe. Such peo- 
ple are likely to be rather long-lived; their ulcers 
are not attended with serious discharges, nor of 
a malignant character; in disposition they are 
rather ferocious than gentle. The diseases I have 
mentioned are peculiar to the men, and besides 
they are liable to any common complaint which 
may be prevailing from the changes of the 
seasons. But the women, in the first place, are 
1 A disease of the skin. 



of a hard constitution, from the waters being 
hard, indigestible, and cold; and their men- 
strual discharges are not regular, but in small 
quantity, and painful. Then they have difficult 
parturition, but arc not very subject to abor- 
tions. And when they do bring forth children, 
they arc unable to nurse them; for the hardness 
and indigestable nature of the water puts away 
their milk. Phthisis frequently supervenes after 
childbirth, for the efforts of it frequently bring 
on ruptures and strains. Children while still 
little are subject to dropsies in the testicle, 
which disappear as they grow older; in such 
a town they are late in attaining manhood. It 
is, as I have now stated, with regard to hot and 
cold winds and cities thus exposed. 

5. Cities that arc exposed to winds between 
the summer and the winter risings of the sun, 
and those the opposite to them, have the follow- 
ing characters: Those which lie to the rising 
of the sun are all likely to be more healthy than 
such as arc turned to the North, or those exposed 
to the hot winds, even if there should not be 
a furlong between them. In the first place, both 
the heat and cold arc more moderate. Then 
such waters as flow to the rising sun, must 
necessarily be clear, fragrant, soft, and delight- 
ful to drink, in such a city. For the sun in rising 
and shining upon them purifies them, by dis- 
pelling the vapors which generally prevail in 
the morning. The persons of the inhabitants 
are, for the most part, well colored and bloom- 
ing, unless some disease counteract. The in- 
habitants have clear voices, and in temper and 
intellect arc superior to those which arc ex- 
posed to the north, and all the productions of 
the country in like manner are better. A city 
so situated resembles the spring as to modera- 
tion between heat and cold, and the diseases 
are few in number, and of a feeble kind, and 
bear a resemblance to the diseases which pre- 
vail in regions exposed to hot winds. The 
women there are very prolific, and have easy 
deliveries. Thus it is with regard to them. 

6. But such cities as lie to the west, and which 
are sheltered from winds blowing from the cast, 
and which the hot winds and the cold winds of 
the north scarcely touch, must necessarily be in 
a very unhealthy situation: in the first place the 
waters are not clear, the cause of which is, be- 
cause the mist prevails commonly in the morn- 
ing, and it is mixed up with the water and de- 
stroys its clearness, for the sun does not shine 
upon the water until he be considerably raised 
above the horizon. And in summer, cold breezes 
from the east blow and dews fall; and in the 



On Airs, Waters, and Places 



latter part of the day the setting sun particular- 
ly scorches the inhabitants, and therefore they 
are pale and enfeebled, and are partly subject 
to all the aforesaid diseases, but no one is pecul- 
iar to them. Their voices are rough and hoarse 
owing to the state of the air, which in such a 
situation is generally impure and unwholesome, 
for they have not the northern winds to purify 
it; and these winds they have are of a very hu- 
mid character, such being the nature of the eve- 
ning breezes. Such a situation of a city bears a 
great resemblance to autumn as regards the 
changes of the day, inasmuch as the difference 
between morning and evening is great. So it is 
with regard to the winds that are conducive to 
health, or the contrary* 

7. And I wish to give an account of the other 
kinds of waters, namely, of such as are whole- 
some and such as are unwholesome, and what 
bad and what good effects may be derived from 
water; for water contributes much towards 
health. Such waters then as are marshy, stag- 
nant, and belong to lakes, are necessarily hot in 
summer, thick, and have a strong smell, since 
they have no current; but being constantly sup- 
plied by rain-water, and the sun heating them, 
they necessarily want their proper color, are un- 
wholesome and form bile; in winter, they be- 
come congealed, cold, and muddy with the 
snow and ice, so that they are most apt to en- 
gender phlegm, and bring on hoarseness; those 
who drink them have large and obstructed 
spleens, their bellies are hard, emaciated, and 
hot; and their shoulders, collar-bones, and faces 
are emaciated; for their flesh is melted down 
and taken up by the spleen, and hence they are 
slender; such persons then are voracious and 
thirsty; their bellies are very dry both above 
and below, so that they require the strongest 
medicines. This disease is habitual to them both 
in summer and in winter, and in addition they 
are very subject to dropsies of a most fatal char- 
acter; and in summer dysenteries, diarrheas, 
and protracted quartan fevers frequently seize 
them, and these diseases when prolonged dis- 
pose such constitutions to dropsies, and thus 
prove fatal. These are the diseases which attack 
them in summer; but in winter younger persons 
are liable to pneumonia, and maniacal affec- 
tions; and older persons to ardent fevers, from 
hardness of the belly. Women are subject to 
oedema and leucophlegmasiar, 1 when pregnant 
they have difficult deliveries; their infants are 
large and swelled, and then during nursing 
they become wasted and sickly, and the lochial 

1 A species of dropsy. 



II 

discharge after parturition does not proceed 
properly with the women. The children are 
particularly subject to hernia, and adults to 
varices and ulcers on their legs, so that persons 
with such constitutions cannot be long-lived, 
but before the usual period they fall into a state 
of premature old age. And further, the women 
appear to be with child, and when the time of 
parturition arrives, the fulness of the belly dis- 
appears, and this happens from dropsy of the 
uterus. Such waters then I reckon bad for every 
purpose. The next to them in badness arc those 
which have their fountains in rocks, so that they 
must necessarily be hard, or come from a soil 
which produces thermal waters, such as those 
having iron, copper, silver, gold, sulphur, alum, 
bitumen, or nitre (soda) in them; for all these 
v are formed by the force of heat. Good waters 
cannot proceed from such a soil, but those that 
are hard and of a heating nature, difficult to pass 
by urine, and of difficult evacuation by the bow- 
els. The best are those which flow from elevated 
grounds, and hills of earth; these arc sweet, 
clear, and can bear a little wine; they are hot 
in summer and cold in winter, for such neces- 
sarily must be the waters from deep wells* But 
those are most to be commended which run to 
the rising of the sun, and especially to the sum- 
mer sun; for such are necessarily more clear, 
fragrant, and light. But all such as are salty, 
crude, and harsh, are not good for drink. But 
there are certain constitutions and diseases with 
which such waters agree when drunk, as I will 
explain presently. Their characters are as fol- 
lows: the best are such as have their fountains 
to the east; the next, those between the summer 
risings and settings of the sun, and especially 
those to the risings; and third, those between 
the summer and winter settings; but the worst 
are those to the south, and the parts between 
the winter rising and setting, and those to the 
south are very bad, but those to the north are 
better. They are to be used as follows: whoever 
is in good health and strength need not mind, 
but may always drink whatever is at hand. But 
whoever wishes to drink the most suitable for 
any disease, may accomplish his purpose by at- 
tending to the following directions: To persons 
whose bellies are hard and easily burnt up, the 
sweetest, the lightest, and the most limpid 
waters will be proper; but those persons whose 
bellies are soft, loose, and pituitous, should 
choose the hardest, those kinds that are most 
crude, and the saltiest, for thus will they be most 
readily dried up; for such waters as arc adapted 
for boiling, and are of a very solvent nature, 



ii Hippocrates 

naturally loosen readily and melt down the 
bowels; but such as are intractable, hard, and 
by no means proper for boiling, these rather 
bind and dry up the bowels. People have de- 
ceived themselves with regard to salt waters, 
from inexperience, for they think these waters 
purgative, whereas they are the very reverse; for 
such waters are crude, and ill adapted for boil- 
ing, so that the belly is more likely to be bound 
up than loosened by them. And thus it is with 
regard to the waters of springs. 

8. 1 will now tell how it is with respect to rain- 
water, and water from snow. Rain waters, then, 
arc the lightest, the sweetest, the thinnest, and 
the clearest; for originally the sun raises and at- 
tracts the thinnest and lightest part of the water, 
as is obvious from the nature of salts; for the 
saltish part is left behind owing to its thickness 
and weight, and forms salts; but the sun at- 
tracts the thinnest part, owing to its lightness, 
and he abstracts this not only from the lakes, 
but also from the sea, and from all things which 
contain humidity, and there is humidity in 
everything; and from man himself the sun 
draws off the thinnest and lightest part of the 
juices. As a strong proof of this, when a man 
walks in the sun, or sits down having a gar- 
ment on, whatever parts of the body the sun 
shines upon do not sweat, for the sun carries 
off whatever sweat makes its appearance; but 
those parts which are covered by the garment, 
or anything else, sweat, for the particles of 
sweat are drawn and forced out by the sun, 
and are preserved by the cover so as not to be 
dissipated by the sun; but when the person 
comes into the shade the whole body equally 
perspires, because the sun no longer shines up- 
on it. Wherefore, of all kinds of water, these 
spoil the soonest; and rain water has a bad 
smell, because its particles are collected and 
mixed together from most objects, so as to spoil 
the soonest. And in addition to this, when at- 
tracted and raised up, being carried about and 
mixed with the air, whatever part of it is tur- 
bid and darkish is separated and removed from 
the other, and becomes cloud and mist, but the 
most attenuated and lightest part is left, and be- 
comes sweet, being heated and concocted by the 
sun, for all other things when concocted be- 
come sweet. While dissipated then and not in 
a state of consistence it is carried aloft. But when 
collected and condensed by contrary winds, it 
falls down wherever it happens to be most con- 
densed. For this is likely to happen when the 
clouds being carried along and moving with 
a wind which does not allow them to rest, sud- 



denly encounters another wind and other clouds 
from the opposite direction: there it is first con- 
densed, and what is behind is carried up to the 
spot, and thus it thickens, blackens, and is con- 
glomerated, and by its weight it falls down and 
becomes rain. Such, to all appearance, are the 
best of waters, but they require to be boiled 
and strained; for otherwise they have a bad 
smell, and occasion hoarseness and thickness of 
the voice to those who drink them. Those from 
snow and ice are all bad, for when once con- 
gealed, they never again recover their former 
nature; for whatever is clear, light, and sweet 
in them, is separated and disappears; but the 
most turbid and weightiest part is left behind. 
You may ascertain this in the following man- 
ner: If in winter you will pour water by meas- 
ure into a vessel and expose it to the open air 
until it is all frozen, and then on the following 
day bring it into a warm situation where the ice 
will thaw, if you will measure the water again 
when dissolved you will find it much less in 
quantity. This is a proof that the lightest and 
thinnest part is dissipated and dried up by the 
congelation, and not the heaviest and thickest, 
for that is impossible: wherefore I hold that 
waters from snow and ice, and those allied to 
them, are the worst of any for all purposes 
whatever. Such are the characters of rain-water, 
and those from ice and snow. 

9. Men become affected with the stone, and 
are seized with diseases of the kidneys, stran- 
gury, sciatica, and become ruptured, when they 
drink all sorts of waters, and those from great 
rivers into which other rivulets run, or from a 
lake into which many streams of all sorts flow, 
and such as are brought from a considerable 
distance. For it is impossible that such waters 
can resemble one another, but one kind is sweet, 
another saltish and aluminous, and some flow 
from thermal springs; and these being all mixed 
up together disagree, and the strongest part al- 
ways prevails; but the same kind is not always 
the strongest, but sometimes one and sometimes 
another, according to the winds, for the north 
wind imparts strength to this water, and the 
south to that, and so also with regard to the 
others. There must be deposits of mud and sand 
in the vessels from such waters, and the afore- 
said diseases must be engendered by them when 
drunk, but why not to all I will now explain. 
When the bowels are loose and in a healthy 
state, and when the bladder is not hot, nor the 
neck of the bladder very contracted, all such 
persons pass water freely, and no concretion 
forms in the bladder; but those in whom the 



On Airs, Waters, and Places 



belly is hot, the bladder must be in the same 
condition; and when pretcrnaturally heated, its 
neck becomes inflamed; and when these things 
happen, the bladder does not expel the urine, 
but raises its heat excessively. And the thinnest 
part of it is secreted, and the purest part is passed 
off in the form of urine, but the thickest and 
most turbid part is condensed and concreted, at 
first in small quantity, but afterwards in great- 
er; for being rolled about in the urine, whatever 
is of a thick consistence it assimilates to itself, 
and thus it increases and becomes indurated. 
And when such persons make water, the stone 
forced down by the urine falls into the neck of 
the bladder and stops the urine, and occasions 
intense pain; so that calculous children rub 
their privy parts and tear at them, as supposing 
that the obstruction to the urine is situated 
there. As a proof that it is as I say, persons af- 
fected with calculus have very limpid urine, 
because the thickest and foulest part remains 
and is concreted. Thus it generally is in cases 
of calculus. It forms also in children from milk, 
when it is not wholesome, but very hot and 
bilious, for it heats the bowels and bladder, so 
that the urine being also heated undergoes the 
same change. And I hold that it is better to give 
children only the most diluted wine, for such 
will least burn up and dry the veins. Calculi do 
not form so readily in women, for in them the 
urethra is short and wide, so that in them the 
urine is easily expelled; neither do they rub the 
pudendum with their hands, nor handle the 
passage like males; for the urethra in women 
opens direct into the pudendum, which is not 
the case with men, neither in them is the urethra 
so wide, and they drink more than children do. 
Thus, or nearly so, is it with regard to them. 

10. And respecting the seasons, one may 
judge whether the year will prove sickly or 
healthy from the following observations: If 
the appearances connected with the rising and 
setting stars be as they should be; if there be 
rains in autumn; if the winter be mild, neither 
very tepid nor unseasonably cold, and if in 
spring the rains be seasonable, and so also in 
summer, the year is likely to prove healthy. But 
if the winter be dry and northerly, and the 
spring showery and southerly, the summer will 
necessarily be of a febrile character, and give 
rise to ophthalmies and dysenteries. For when 
suffocating heat sets in all of a sudden, while 
the earth is moistened by the vernal showers, 
and by the south wind, the heat is necessarily 
doubled from the earth, which is thus soaked 
by rain and heated by a burning sun, while, at 



the same time, men's bellies are not in an order- 
ly state, nor the brain properly dried; for it is 
impossible, after such a spring, but that the 
body and its flesh must be loaded with humors, 
so that very acute fevers will attack all, but es- 
pecially those of a phlegmatic constitution. 
Dysenteries are also likely to occur to women 
and those of a very humid temperament. And 
if at the rising of the Dogstar rain and wintery 
storms supervene, and if the etesian winds blow, 
there is reason to hope that these diseases will 
cease, and that the autumn will be healthy; but 
if not, it is likely to be a fatal season to children 
and women, but least of all to old men; and 
that convalescents will pass into quartans, and 
from quartans into dropsies; but if the winter 
be southerly, showery and mild, but the spring 
northerly, dry, and of a wintry character, in the 
first place women who happen to be with child, 
and whose accouchement should take place in 
spring, are apt to miscarry; and such as bring 
forth, have feeble and sickly children, so that 
they either die presently or are tender, feeble, 
and sickly, if they live. Such is the case with the 
women. The others are subject to dysenteries 
and dry ophthalmies, and some have catarrhs 
beginning in the head and descending to the 
lungs. Men of a phlegmatic temperament are 
likely to have dysenteries; and women, also, 
from the humidity of their nature, the phlegm 
descending downwards from the brain; those 
who are bilious, too, have dry ophthalmies from 
the heat and dryness of their flesh; the aged, too, 
have catarrhs from their flabbiness and melting 
of the veins, so that some of them die suddenly 
and some become paralytic on the right side or 
the left. For when, the winter being southerly 
and the body hot, the blood and veins are not 
properly constringed; a spring that is northerly, 
dry, and cold, having come on, the brain when 
it should have been expanded and purged, by 
the coryza and hoarseness is then constringed 
and contracted, so that the summer and the 
heat occurring suddenly, and a change super- 
vening, these diseases fall out. And such cities 
as lie well to the sun and winds, and use good 
waters, feel these changes less, but such as use 
marshy and pooly waters, and lie well both as 
regards the winds and the sun, these all feel it 
more. And if the summer be dry, those diseases 
soon cease, but if rainy, they are protracted; 
and there is danger of any sore that there is be- 
coming phagedenic from any cause; and lien- 
teries and dropsies supervene at the conclusion 
of diseases; for the bowels are not readily dried 
up. And if the summer be rainy and southerly, 



Hippocrates 



and next the autumn, the winter must, of neces- 
sity, be sickly, and ardent fevers are likely to 
attack those that are phlegmatic, and more 
elderly than forty years, and pleurisies and peri- 
pneumonies those that are bilious. But if the 
summer is parched and northerly, but the au- 
tumn rainy and southerly, headache and spha- 
celus of the brain are likely to occur; and in 
addition hoarseness, coryza, coughs, and in 
some cases, consumption. But if the season is 
northerly and without water, there being no 
rain, neither after the Dogstar nor Arcturus; 
this state agrees best with those who are natu- 
rally phlegmatic, with those who are of a hu- 
mid temperament, and with women; but it is 
most inimical to the bilious; for they become 
much parched up, and ophthalmies of a dry na- 
ture supervene, fevers both acute and chronic, 
and in some cases melancholy; for the most 
humid and watery part of the bile being con- 
sumed, the thickest and most acrid portion is 
left, and of the blood likewise, when these dis- 
eases come upon them. But all these are bene- 
ficial to the phlegmatic, for they are thereby 
dried up, and reach winter not oppressed with 
humors, but with them dried up. 

1 1 . Whoever studies and observes these things 
may be able to foresee most of the effects which 
will result from the changes of the seasons; and 
one ought to be particularly guarded during 
the greatest changes of the seasons, and neither 
willingly give medicines, nor apply the cautery 
to the belly, nor make incisions there until ten 
or more days be past. Now, the greatest and 
most dangerous are the two solstices, and es- 
pecially the summer, and also the two equi- 
noxes, but especially the autumnal. One ought 
also to be guarded about the rising of the stars, 
especially of the Dogstar, then of Arcturus, and 
then the setting of the Pleiades; for diseases are 
especially apt to prove critical in those days, 
and some prove fatal, some pass off, and all 
others change to another form and another con- 
stitution. So it is with regard to them. 

12. I wish to show, respecting Asia and 
Europe, how, in all respects, they differ from 
one another, and concerning the figure of the 
inhabitants, for they arc different, and do not 
at all resemble one another. To treat of all 
would be a long story, but I will tell you how 
I think it is with regard to the greatest and 
most marked differences. I say, then, that Asia 
differs very much from Europe as to the nature 
of all things, both with regard to the produc- 
tions of the earth and the inhabitants, for every- 
thing is produced much more beautiful and 



large in Asia; the country is milder, and the 
dispositions of the inhabitants also are more 
gentle and affectionate. The cause of this is the 
temperature of the seasons, because it lies in the 
middle of the risings of the sun towards the 
cast, and removed from the cold (and heat), 
for nothing tends to growth and mildness so 
much as when the climate has no predominant 
quality, but a general equality of temperature 
prevails. It is not everywhere the same with re- 
gard to Asia, but such parts of the country as 
lie intermediate between the heat and the cold, 
are the best supplied with fruits and trees, and 
have the most genial climate, and enjoy the pur- 
est waters, both celestial and terrestrial. For nei- 
ther are they much burnt up by the heat, nor 
dried up by the drought and want of rain, nor 
do they suffer from the cold; since they are well 
watered from abundant showers and snow, and 
the fruits of the season, as might be supposed, 
grow in abundance, both such as are raised 
from seed that has been sown, and such plants 
as the earth produces of its own accord, the 
fruits of which the inhabitants make use of, 
training them from their wild state and trans- 
planting them to a suitable soil; the cattle also 
which are reared there are vigorous, particular- 
ly prolific, and bring up young of the fairest 
description; the inhabitants too, are well fed, 
most beautiful in shape, of large stature, and 
differ little from one another either as to figure 
or size; and the country itself, both as regards 
its constitution and mildness of the seasons, 
may be said to bear a close resemblance to the 
spring. Manly courage, endurance of suffering, 
laborious enterprise, and high spirit, could not 
be produced in such a state of things either 
among the native inhabitants or those of a dif- 
ferent country, for there pleasure necessarily* 
reigns. For this reason, also, the forms of wild 
beasts there are much varied. Thus it is, as I 
think, with the Egyptians and Libyans. 

13. But concerning those on the right hand 
of the summer risings of the sun as far as the 
Palus Maeotis ( for this is the boundary of Europe 
and Asia), it is with them as follows: the in- 
habitants there differ far more from one an- 
other than those I have treated of above, owing 
to the differences of the seasons and the nature 
of the soil. But with regard to the country it- 
self, matters are the same there as among all 
other men; for where the seasons undergo the 
greatest and most rapid changes, there the coun- 
try is the wildest and most unequal; and you 
will find the greatest variety of mountains, for- 
ests, plains, and meadows; but where the sea- 



On Airs, Waters, and Places 



sons do not change much there the country is 
the most even; and, if one will consider it, so 
is it also with regard to the inhabitants; for the 
nature of some is like to a country covered with 
trees and well watered; of some, to a thin soil 
deficient in water; of others, to fenny and marshy 
places; and of some again, to a plain of bare and 
parched land. For the seasons which modify 
their natural frame of body are varied, and the 
greater the varieties of them the greater also will 
be the differences of their shapes. 

14. 1 will pass over the smaller differences a- 
mong the nations, but will now treat of such as 
are great either from nature, or custom; and, 
first, concerning the Macrocephali. There is no 
other race of men which have heads in the least 
resembling theirs. At first, usage was the prin- 
cipal cause of the length of their head, but now 
nature cooperates with usage. They think those 
the most noble who have the longest heads. It 
is thus with regard to the usage: immediately 
after the child is born, and while its head is still 
tender, they fash ion it with their hands, and con- 
strain it to assume a lengthened shape by apply- 
ing bandages and other suitable contrivances 
whereby the spherical form of the head is de- 
stroyed, and it is made to increase in length. 
Thus, at first, usage operated, so that this con- 
stitution was the result of force : but, in the course 
of time, it was formed naturally; so that usage 
had nothing to do with it; for the semen comes 
from all parts of the body, sound from the sound 
parts, and unhealthy from the unhealthy parts. 
If, then, children with bald heads are born to 
parents with bald heads; and children with blue 
eyes to parents who have blue eyes; and if the 
children of parents having distorted eyes squint 
also for the most part; and if the same may be 
said of other forms of the body, what is to pre- 
vent it from happening that a child with a long 
head should be produced by a parent having a 
long head? But now these things do not happen 
as they did formerly, for the custom no longer 
prevails owing to their intercourse with other 
men. Thus it appears to me to be with regard 
to them. 

15. As to the inhabitants of Phasis, their coun- 
try is fenny, warm, humid, and wooded; copi- 
ous and severe rains occur there at all seasons; 
and the life of the inhabitants is spent among 
the fens; for their dwellings are constructed of 
wood and reeds, and are erected amidst the wa- 
ters; they seldom practice walking either to the 
city or the market, but sail about, up and down, 
in canoes constructed out of single trees, for there 
are many canals there. They drink the hot and 



stagnant waters, both when rendered putrid by 
the sun, and when swollen with rains. The Pha- 
sis itself is the most stagnant of all rivers, and 
runs the smoothest; all the fruits which spring 
there are unwholesome, of feeble and imperfect 
growth, owing to the redundance of water, and 
on this account they do not ripen, for much va- 
por from the waters overspreads the country. 
For these reasons the Phasians have shapes dif- 
ferent from those of all other men; for they are 
large in stature, and of a very gross habit of body, 
so that not a joint nor vein is visible; in color 
they are sallow, as if affected with jaundice. Of 
all men they have the roughest voices, from their 
breathing an atmosphere which is not clear, but 
misty and humid; they are naturally rather lan- 
guid in supporting bodily fatigue. The seasons 
undergo but little change either as to heat or 
cold; their winds for the most part are souther- 
ly, with the exception of one peculiar to the coun- 
try, which sometimes blows strong, is violent 
and hot, and is called by them the wind cen- 
chron. The north wind scarcely reaches them, 
and when it does blow it is weak and gentle. 
Thus it is with regard to the different nature and 
shape of the inhabitants of Asia and Europe. 

16. And with regard to the pusillanimity and 
cowardice of the inhabitants, the principal 
reason the Asiatics are more unwarlike and of 
gentler disposition than the Europeans is, the 
nature of the seasons, which do not undergo 
any great changes either to heat or cold, or 
the like; for there is neither excitement of the un- 
derstanding nor any strong change of the body 
whereby the temper might be ruffled and they 
be roused to inconsiderate emotion and passion, 
rather than living as they do always in the same 
state. It is changes of all kinds which arouse the 
understanding of mankind, and do not allow 
them to get into a torpid condition. For these 
reasons, it appears to me, the Asiatic race is fee- 
ble, and further, owing to their laws; for mon- 
archy prevails in the greater part of Asia, and 
where men are not their own masters nor in- 
dependent, but are the slaves of others, it is not 
a matter of consideration with them how they 
may acquire military discipline, but how they 
may seem not to be warlike, for the dangers are 
not equally shared, since they must serve as sol- 
diers, perhaps endure fatigue, and die for their 
masters, far from their children, their wives, and 
other friends; and whatever noble and manly 
actions they may perform lead only to the ag- 
grandizement of their masters, whilst the fruits 
which they reap are dangers and death; and, in 
addition to all this, the lands of such persons 



1 6 Hippocrates 

must be laid waste by the enemy and want of cul- 
ture. Thus, then, if any one be naturally warlike 
and courageous, his disposition will be changed 
by the institutions. As a strong proof of all this, 
such Greeks or barbarians in Asia as are not 
under a despotic form of government, but arc 
independent, and enjoy the fruits of their own 
labors, are of all others the most warlike; for 
these encounter dangers on their own account, 
bear the prizes of their own valor, and in like 
manner endure the punishment of their own 
cowardice. And you will find the Asiatics dif- 
fering from one another, for some are better and 
others more dastardly; of these differences, as 
I stated before, the changes of the seasons are 
the cause. Thus it is with Asia. 

17. In Europe there is a Scythian race, called 
Sauromatae, which inhabits the confines of the 
Palus Maeotis, and is different from all other 
races. Their women mount on horseback, use 
the bow, and throw the javelin from their horses, 
and fight with their enemies as long as they are 
virgins; and they do not lay aside their virginity 
until they kill three of their enemies, nor have 
any connection with men until they perform 
the sacrifices according to law. Whoever takes 
to herself a husband, gives up riding on horse- 
back unless the necessity of a general expedition 
obliges her. They have no right breast; for while 
still of a tender age their mothers heat strongly 
a copper instrument constructed for this very 
purpose, and apply it to the right breast, which 
is burnt up, and its development being arrested, 
all the strength and fullness are determined to 
the right shoulder and arm. 

1 8. As the other Scythians have a peculiarity 
of shape, and do not resemble any other, the 
same observation applies to the Egyptians, only 
that the latter are oppressed by heat and the 
former by cold. What is called the Scythian des- 
ert is a prairie, rich in meadows, high-lying, 
and well watered; for the rivers which carry off 
the water from the plains are large. There live 
those Scythians which are called Nomades, be- 
cause they have no houses, but live in wagons. 
The smallest of these wagons have four wheels, 
but some have six; they are covered in with felt, 
and they arc constructed in the manner of houses, 
some having but a single apartment, and some 
three; they are proof against rain, snow, and 
winds. The wagons are drawn by yokes of ox- 
en, some of two and others of three, and all with- 
out horns, for they have no horns, owing to the 
cold. In these wagons the women live, but the 
men are carried about on horses, and the sheep, 
oxen, and horses accompany them; and they 



remain on any spot as long as there is provender 
for their cattle, and when that fails they migrate 
to some other place. They eat boiled meat, and 
drink the milk of mares, and also eat hippacc, 
which is cheese prepared from the milk of the 
mare. Such is their mode of life and their cus- 
toms. 

i9.In respect of the seasons and figure of body, 
the Scythian race, like the Egyptian, have a uni- 
formity of resemblance, different from all other 
nations; they are by no means prolific, and the 
wild beasts which are indigenous there are small 
in size and few in number, for the country lies 
under the Northern Bears, and the Rhiphaean 
mountains, whence the north wind blows; the 
sun comes very near to them only when in the 
summer solstice, and warms them but for a short 
period, and not strongly; and the winds blow- 
ing from the hot regions of the earth do not reach 
them, or but seldom, and with little force; but 
the winds from the north always blow, con- 
gealed, as they are, by the snow, ice, and much 
water, for these never leave the mountains, 
which are thereby rendered uninhabitable. A 
thick fog covers the plains during the day, and 
amidst it they live, so that winter may be said 
to be always present with them; or, if they have 
summer, it is only for a few days, and the heat 
is not very strong. Their plains are high-lying 
and naked, not crowned with mountains, but 
extending upwards under the Northern Bears. 
The wild beasts there are not large, but such as 
can be sheltered underground; for the cold of 
winter and the barrenness of the country pre- 
vent their growth, and because they have no 
covert nor shelter. The changes of the seasons, 
too, are not great nor violent, for, in fact, they 
change gradually; and therefore their figures re- 
semble one another, as they all equally use the 
same food, and the same clothing summer and 
winter, respiring a humid and dense atmos- 
phere, and drinking water from snow and ice; 
neither do they make any laborious exertions, 
for neither body nor mind is capable of endur- 
ing fatigue when the changes of the seasons are 
not great.For these reasons their shapes are gross 
and fleshy, with ill-marked joints, of a humid 
temperament, and deficient in tone: the inter- 
nal cavities, and especially those of the intestines, 
are full of humors; for the belly cannot possibly 
be dry in such a country, with such a constitu- 
tion and in such a climate; but owing to their 
fat, and the absence of hairs from their bodies, 
their shapes resemble one another, the males be- 
ing all alike, and so also with the women; for 
the seasons being of a uniform temperature, no 



On Airs, Waters, and Places 



corruption or deterioration takes place in the 
concretion of the semen, unless from some vio- 
lent cause, or from disease. 

20. 1 will give you a strong proof of the hu- 
midity (laxity? ) of their constitutions. You will 
find the greater part of the Scythians, and all 
the Nomades, with marks of the cautery on their 
shoulders, arms, wrists, breasts, hip-joints, and 
loins, and that for no other reason but the hu- 
midity and flabbiness of their constitution, for 
they can neither strain with their bows, nor 
launch the javelin from their shoulder owing to 
their humidity and atony: but when they are 
burnt, much of the humidity in their joints is 
dried up, and they become better braced, better 
fed, and their joints get into a more suitable con- 
dition. They are flabby and squat at first, be- 
cause, as in Egypt, they are not swathed ( ? ) ; 
and then they pay no attention to horsemanship, 
so that they may be adepts at it; and because of 
their sedentary mode of life; for the males, when 
they cannot be carried about on horseback, sit 
the most of their time in the wagon, and rarely 
practise walking, because of their frequent mi- 
grations and shif tings of situation; and as to the 
women, it is amazing how flabby and sluggish 
they are. The Scythian race are tawny from the 
cold, and not from the intense heat of the sun, 
for the whiteness of the skin is parched by the 
cold, and becomes tawny. 

21 . It is impossible that persons of such a con- 
stitution could be prolific, for, with the man, the 
sexual desires are not strong, owing to the laxity 
of his constitution, the softness and coldness of 
his belly, from all which causes it is little likely 
that a man should be given to venery; and be- 
sides, from being jaded by exercise on horse- 
back, the men become weak in their desires. On 
the part of the men these are the causes; but on 
that of the women, they are embonpoint and 
humidity; for the womb cannot take in the se- 
men, nor is the menstrual discharge such as it 
should be, but scanty and at too long intervals; 
and the mouth of the womb is shut up by fat 
and does not admit the semen; and, moreover, 
they themselves are indolent and fat, and their 
bellies cold and soft. From these causes the Scy- 
thian race is not prolific. Their female servants 
furnish a strong proof of this; for they no sooner 
have connection with a man than they prove 
with child, owing to their active course of life 
and the slenderness of body. 

22. And, in addition to these, there are many 
eunuchs among the Scythians, who perform fe- 
male work, and speak like women. Such per- 
sons are called effeminates. The inhabitants of 



the country attribute the cause of their impo- 
tence to a god, and venerate and worship such 
persons, every one dreading that the like might 
befall himself; but to me it appears that such 
affections are just as much divine as all others 
are, and that no one disease is either more di- 
vine or more human than another, but that all 
are alike divine, for that each has its own na- 
ture, and that no one arises without a natural 
cause. But I will explain how I think that the 
affection takes its rise. From continued exercise 
on horseback they are seized with chronic de- 
fluxions in their joints owing to their legs al- 
ways hanging down below their horses; they aft- 
erwards become lame and stiff at the hip-joint, 
such of them, at least, as are severely attacked 
with it. They treat themselves in this way: when 
the disease is commencing, they open the vein 
behind either ear, and when the blood flows, 
sleep, from feebleness, seizes them, and after- 
wards they awaken, some in good health and 
others not. To me it appears that the semen is 
altered by this treatment, for there are veins be- 
hind the ears which, if cut, induce impotence; 
now, these veins would appear to me to be cut. 
Such persons afterwards, when they go in to 
women and cannot have connection with them, 
at first do not think much about it, but remain 
quiet; but when, after making the attempt two, 
three, or more times, they succeed no better, 
fancying they have committed some offence 
against the god whom they blame for the affec- 
tion, they put on female attire, reproach them- 
selves for effeminacy, play the part of women, 
and perform the same work as women do. This 
the rich among the Scythians endure, not the 
basest, but the most noble and powerful, owing 
to their riding on horseback; for the poor are 
less affected, as they do not ride on horses. And 
yet, if this disease had been more divine than 
the others, it ought not to have befallen the most 
noble and the richest of the Scythians alone, but 
all alike, or rather those who have little, as not 
being able to pay honors to the gods, if, indeed, 
they delight in being thus rewarded by men, 
and grant favors in return; for it is likely that 
the rich sacrifice more to the gods, and dedicate 
more votive offerings, inasmuch as they have 
wealth, and worship the gods; whereas the poor, 
from want, do less in this way, and, moreover, 
upbraid the gods for not giving them wealth, so 
that those who have few possessions were more 
likely to bear the punishments of these offences 
than the rich. But, as I formerly said, these af- 
fections are divine just as much as others, for 
each springs from a natural cause, and this dis- 



i8 



Hippocrates 



case arises among the Scythians from such a 
cause as I have stated. But it attacks other men 
in like manner, for whenever men ride much 
and very frequently on horseback, then many 
are affected with rheums in the joints, sciatica, 
and gout, and they are inept at venery. But these 
complaints befall the Scythians, and they are the 
most impotent of men for the aforesaid causes, 
and because they always wear breeches, and 
spend the most of their time on horseback, so 
as not to touch their privy parts with the hands, 
and from the cold and fatigue they forget the 
sexual desire, and do not make the attempt un- 
til after they have lost their virility. Thus it is 
with the race of the Scythians. 

23. The other races in Europe differ from one 
another, both as to stature and shape, owing to 
the changes of the seasons, which are very great 
and frequent, and because the heat is strong, 
the winters severe, and there are frequent rains, 
and again protracted droughts, and winds, from 
which many and diversified changes are in- 
duced. These changes are likely to have an ef- 
fect upon generation in the coagulation of the 
semen, as this process cannot be the same in 
summer as in winter, nor in rainy as in dry 
weather; wherefore, I think, that the figures of 
Europeans differ more than those of Asiatics; 
and they differ very much from one another as 
to stature in the same city; for vitiations of the 
semen occur in its coagulation more frequently 
during frequent changes of the seasons, than 
where they are alike and equable. And the same 
may be said of their dispositions, for the wild, 
and unsociable, and the passionate occur in such 
a constitution; for frequent excitement of the 
mind induces wildness, and extinguishes socia- 
bleness and mildness of disposition, and there- 
fore I think the inhabitants of Europe more cou- 
rageous than those of Asia; for a climate which 
is always the same induces indolence, but a 
changeable climate, laborious exertions both of 
body and mind; and from rest and indolence 
cowardice is engendered, and from laborious 
exertions and pains, courage. On this account 
the inhabitants of Europe are more warlike than 
the Asiatics, and also owing to their institutions, 
because they are not governed by kings like the 
latter, for where men are governed by kings 
there they must be very cowardly, as I have stat- 
ed before; for their souls are enslaved, and they 
will not willingly, or readily undergo dangers 
in order to promote the power of another; but 
those that are free undertake dangers on their 
own account, and not for the sake of others; 
they court hazard and go out to meet it, for they 



themselves bear off the rewards of victory, and 
thus their institutions contribute not a little to 
their courage. 

Such is the general character of Europe and 
Asia. 

24. And there are in Europe other tribes, dif- 
fering from one another in stature, shape, and 
courage: the differences are those I formerly 
mentioned, and will now explain more clearly. 
Such as inhabit a country which is mountain- 
ous, rugged, elevated, and well watered, and 
where the changes of the seasons are very great, 
are likely to have great variety of shapes among 
them, and to be naturally of an enterprising and 
warlike disposition; and such persons are apt to 
have no little of the savage and ferocious in their 
nature; but such as dwell in places which are 
low-lying, abounding in meadows and ill venti- 
lated, and who have a larger proportion of hot 
than of cold winds, and who make use of warm 
waters these are not likely to be of large stat- 
ure nor well proportioned, but are of a broad 
make, fleshy, and have black hair; and they are 
rather of a dark than of a light complexion, and 
are less likely to be phlegmatic than bilious; 
courage and laborious enterprise are not natu- 
rally in them, but may be engendered in them 
by means of their institutions. And if there be 
rivers in the country which carry off the stag- 
nant and rainwater from it, these may be whole- 
some and clear; but if there be no rivers, but 
the inhabitants drink the waters of fountains, 
and such as are stagnant and mar shy, they must 
necessarily have prominent belliesand enlarged 
spleens. But such as inhabit a high country, and 
one that is level, windy, and well-watered, will 
be large of stature, and like to one another; but 
their minds will be rather unmanly and gentle. 
Those who live on thin, ill-watered, and bare 
soils, and not well attempered in the changes of 
the seasons, in such a country they are likely to 
be in their persons rather hard and well braced, 
rather of a blond than a dark complexion, and 
in disposition and passions haughty and self- 
willed. For, where the changes of the seasons 
are most frequent, and where they differ most 
from one another, there you will find their forms, 
dispositions, and nature the most varied. These 
are the strongest of the natural causes of dif- 
ference, and next the country in which one lives, 
and the waters; for, in general, you will find 
the forms and dispositions of mankind to cor- 
respond with the nature of the country; for 
where the land is fertile, soft, and well-watered, 
and supplied with waters from very elevated 
situations, so as to be hot in summer and cold 



The Book of Prognostics 

in winter, and where the seasons are fine, there 
the men are fleshy, have ill-formed joints, and 
are of a humid temperament; they are not dis- 
posed to endure labor, and, for the most part, 
are base in spirit; indolence and sluggishness 
are visible in them, and to the arts they are dull, 
and not clever nor acute. When the country is 
bare, not fenced, and rugged, blasted by the win- 
ter and scorched by the sun, there you may see 
the men hardy, slender, with well-shaped joints, 
well-braced, and shaggy; sharp industry and vig- 



ilance accompany such a constitution; in morals 
and passions they are haughty and opinionative, 
inclining rather to the fierce than to the mild; 
and you will find them acute and ingenious as 
regards the arts, and excelling in military af- 
fairs; and likewise all the other productions of 
the earth corresponding to the earth itself. Thus 
it is with regard to the most opposite natures 
and shapes; drawing conclusions from them, 
you may judge of the rest without any risk of 
error. 



The Book of Prognostics 



IT APPEARS to me a most excellent thing 
for the physician to cultivate Prognosis; for by 
foreseeing and fore tell ing, in the presence of the 
sick, the present, the past, and the future, and 
explaining the omissions which patients have 
been guilty of, 1 he will be the more readily be- 
lieved to be acquainted with the circumstances 
of the sick; so that men will have confidence to 
intrust themselves to such a physician. And he 
will manage the cure best who has foreseen 
what is to happen from the present state of mat- 
ters. For it is impossible to make all the sick 
well; this, indeed, would have been better than 
to be able to foretell what is going to happen; 
but since men die, some even before calling the 
physician, from the violence of the disease, and 
some die immediately after calling him, having 
lived, perhaps, only one day or a little longer, 
and before the physician could bring his art to 
counteract the disease; it therefore becomes nec- 
essary to know the nature of such affections, 
how far they are above the powers of the con- 
stitution; and, moreover, if there be anything 
divine in the diseases, and to learn a foreknowl- 
edge of this also. Thus a man will be the more 
esteemed to be a good physician, for he will be 
the better able to treat those aright who can be 
saved, from having long anticipated every thing; 
and by seeing and announcing beforehand those 
who will live and those who will die, he will 
thus escape censure. 

2. He should observe thus in acute diseases: 
first, the countenance of the patient, if it be like 
those of persons in health, and more so, if like 
itself, for this is the best of all; whereas the most 

1 Galen, in his Commentary on this clause of the 
sentence, remarks that patients arc justly disposed 
to form a high opinion of a physician who points 
out to them symptoms of their complaint which 
they themselves had omitted to mention to him. 



opposite to it is the worst, such as the following; 
a sharp nose, hollow eyes, collapsed temples; 
the ears cold, contracted, and their lobes turned 
out: the styn about the forehead being rough, 
distended, and parched; the color of the whole 
face being green, blac\, livid, or lead-colored. 
If the countenance be such at the commence- 
ment of the disease, and if this cannot be ac- 
counted for from the other symptoms, inquiry 
must be made whether the patient has long 
wanted sleep; whether his bowels have been very 
loose; and whether he has suffered from want 
of food; and if any of these causes be confessed 
to, the danger is to be reckoned so far less; and 
it becomes obvious, in the course of a day and a 
night, whether or not the appearance of the 
countenance proceeded from these causes. But 
if none of these be said to exist, and if the symp- 
toms do not subside in the aforesaid time, it is 
to be known for certain that death is at hand. 
And, also, if the disease be in a more advanced 
stage either on the third or fourth day, and the 
countenance be such, the same inquiries as for- 
merly directed are to be made, and the other 
symptoms are to be noted, those in the whole 
countenance, those on the body, and those in 
the eyes; for if they shun the light, or weep in- 
voluntarily, or squint, or if the one be less than 
the other, or if the white of them be red, livid, 
or has black veins in it; if there be a gum upon 
the eyes, if they are restless, protruding, or are 
become very hollow; and if the countenance be 
squalid and dark, or the color of the whole face 
be changed all these are to be reckoned bad 
and fatal symptoms. The physician should also 
observe the appearance of the eyes from below 
the eyelids in sleep; for when a portion of the 
white appears, owing to the eyelids not being 
closed together, and when this is not connected 
with diarrhea or purgation from medicine, or 



io Hippocrates 

when the patient does not sleep thus from habit, 
it is to be reckoned an unfavorable and very 
deadly symptom; but if the eyelid be contracted, 
livid, or pale, or also the lip, or nose, along with 
some of the other symptoms, one may know for 
certain that death is close at hand. It is a mortal 
symptom, also, when the lips are relaxed, pen- 
dent, cold, and blanched. 

3. It is well when the patient is found by his 
physician reclining upon either his right or his 
left side, having his hands, neck, and legs slightly 
bent, and the whole body lying in a relaxed state, 
for thus the most of persons in health recline, 
and these arc the best of postures which most 
resemble those of healthy persons. But to lie up- 
on one's back, with the hands, neck, and the legs 
extended, is far less favorable. And if the pa- 
tient incline forward, and sink down to the foot 
of the bed, it is a still more dangerous symptom; 
but if he be found with his feet naked and not 
sufficiently warm, and the hands, neck, and 
legs tossed about in a disorderly manner and 
naked, it is bad, for it indicates aberration of in- 
tellect. It is a deadly symptom, also, when the 
patient sleeps constantly with his mouth open, 
having his legs strongly bent and plaited togeth- 
er, while he lies upon his back; and to he upon 
one's belly, when not habitual to the patient to 
sleep thus while in good health, indicates de- 
lirium, or pain in the abdominal regions. And 
for the patient to wish to sit erect at the acme 
of a disease is a bad symptom in all acute dis- 
eases, but particularly so in pneumonia. To grind 
the teeth in fevers, when such has not been the 
custom of the patient from childhood, indi- 
cates madness and death, both which dangers 
are to be announced beforehand as likely to hap- 
pen; and if a person in delirium do this it is a 
very deadly symptom. And if the patient had an 
ulcer previously, or if one has occurred in the 
course of the disease, it is to be observed; for if 
the man be about to die the sore will become 
livid and dry, or yellow and dry before death. 

4. Respecting the movement of the hands I 
have these observations to make: When in acute 
fevers, pneumonia, phrenitis, or headache, the 
hands are waved before the face, hunting 
through empty space, as if gathering bits of 
straw, picking the nap from the coverlet, or 
tearing chaff from the wall all such symptoms 
are bad and deadly. 

5. Respiration, when frequent, indicates pain 
or inflammation in the parts above the dia- 
phragm: a large respiration performed at a 
great interval announces delirium; but a cold 
respiration at nose or mouth is a very fatal symp- 



tom. Free respiration is to be looked upon as 
contributing much to the safety of the patient 
in all acute diseases, such as fevers, and those 
complaints which come to a crisis in forty days. 

6. Those sweats are the best in all acute dis- 
eases which occur on the critical days, and com- 
pletely carry off the fever. Those are favorable, 
too, which taking place over the whole body, 
show that the man is bearing the disease better. 
But those that do not produce this effect are not 
beneficial. The worst are cold sweats, confined 
to the head, face, and neck; these in an acute 
fever prognosticate death, or in a milder one, a 
prolongation of the disease; and sweats which 
occur over the whole body, with the characters 
of those confined to the neck, are in like man- 
ner bad. Sweats attended with a miliary erup- 
tion, and taking place about the neck, are bad; 
sweats in the form of drops and of vapour are 
good. One ought to know the entire character 
of sweats, for some are connected with prostra- 
tion of strength in the body, and some with in- 
tensity of the inflammation. 

7. That state of the hypochondrium is best 
when it is free from pain, soft, and of equal size 
on the right side and the left. But if inflamed, 
or painful, or distended; or when the right and 
left sides are of disproportionate sizes; all 
these appearances are to be dreaded. And if 
there be also pulsation in the hypochondrium, 
it indicates perturbation or delirium; and the 
physician should examine the eyes of such per- 
sons; for if their pupils be in rapid motion, such 
persons may be expected to go mad. A swell- 
ing in the hypochondrium, that is hard and pain- 
ful, is very bad, provided it occupy the whole 
hypochondrium; but if it be on either side, it is 
less dangerous when on the left. Such swellings 
at the commencement of the disease prognosti- 
cate speedy death; but if the fever has passed 
twenty days, and the swelling has not subsided, 
it turns to a suppuration. A discharge of blood 
from the nose occurs to such in the first period, 
and proves very useful; but inquiry should be 
made if they have headache or indistinct vi- 
sion; for if there be such, the disease will be de- 
termined thither. The discharge of blood is rath- 
er to be expected in those who are younger than 
thirty-five years. Such swellings as are soft, free 
from pain, and yield to the finger, occasion 
more protracted crises, and arc less dangerous 
than the others. But if the fever continue be- 
yond sixty days, without any subsidence of the 
swelling, it indicates that empycma is about to 
take place; and a swelling in any other part of 
the cavity will terminate in like manner. Such, 



The Book of Prognostics 



then, as are painful, hard, and large, indicate 
danger of speedy death; but such as are soft, 
free of pain, and yield when pressed with the 
finger, are more chronic than these. Swellings in 
the belly less frequently form abscesses than 
those in the hypochondrium; and seldomest of 
all, those below the navel are converted into 
suppuration; but you may rather expect a hem- 
orrhage from the upper parts. But the suppura- 
tion of all protracted swellings about these parts 
is to be anticipated. The collections of matter 
there are to be thus judged of: such as are de- 
termined outwards are the best when they are 
small, when they protrude very much, and 
swell to a point; such as are large and broad, and 
which do not swell out to a sharp point, are the 
worst. Of such as break internally, the best are 
those which have no external communication, 
but are covered and indolent; and when the 
whole place is free from discoloration. That pus 
is best which is white, homogeneous, smooth, 
and not at all fetid; the contrary to this is the 
worst. 

8. All dropsies arising from acute diseases are 
bad; for they do not remove the fever, and are 
very painful and fatal. The most of them com- 
mence from the flanks and loins, but some from 
the liver; in those which derive their origin 
from the flanks and loins the feet swell, pro- 
tracted diarrhoeas supervene, which neither re- 
move the pains in the flanks and loins, nor sof- 
ten the belly, but in dropsies which are connect- 
ed with the liver there is a tickling cough, with 
scarcely any perceptible expectoration, and the 
feet swell; there arc no evacuations from the 
bowels, unless such as are hard and forced; and 
there are swellings about the belly, sometimes 
on the one side and sometimes on the other, and 
these increase and diminish by turns. 

9. It is a bad symptom when the head, hands, 
and feet are cold, while the belly and sides are 
hot; but it is a very good symptom when the 
whole body is equally hot. The patient ought to 
be able to turn round easily, and to be agile 
when raised up; but if he appear heavy in the 
rest of his body as well as in his hands and feet, 
it is more dangerous; and if, in addition to the 
weight, his nails and fingers become livid, im- 
mediate death may be anticipated; and if the 
hands and feet be black it is less dangerous than 
if they be livid, but the other symptoms must be 
attended to; for if he appear to bear the illness 
well, and if certain of the salutary symptoms 
appear along with these there may be hope that 
the disease will turn to a deposition, so that the 
man may recover; but the blackened parts of 



II 

the body will drop off. When the testicles and 
members arc retracted upwards, they indicate 
strong pains and danger of death. 

10. With regard to sleep as is usual with us 
in health, the patient should wake during the 
day and sleep during the night. If this rule be 
anywise altered it is so far worse: but there will 
be little harm provided he sleep in the morning 
for the third part of the day; such sleep as takes 
place after this time is more unfavorable; but 
the worst of all is to get no sleep cither night or 
day; for it follows from this symptom that the 
insomnolency is connected with sorrow and 
pains, or that he is about to become delirious. 

1 1 . The excrement is best which is soft and 
consistent, is passed at the hour which was cus- 
tomary to the patient when in health, in quan- 
tity proportionate to the ingesta; for when the 
passages are such, the lower belly is in a healthy 
state. But if the discharges be fluid, it is favor- 
able that they are not accompanied with a noise, 
nor are frequent, nor in great quantity; for the 
man being oppressed by frequently getting up, 
must be deprived of sleep; and if the evacua- 
tions be both frequent and large, there is danger 
of his falling into deliquium animi. But in pro- 
portion to the ingesta he should have evacua- 
tions twice or thrice in the day, once at night 
and more copiously in the morning, as is cus- 
tomary with a person in health. The fasces 
should become thicker when the disease is tend- 
ing to a crisis; they ought to be yellowish and 
not very fetid. It is favorable that round worms 
be passed with the discharges when the disease 
is tending to a crisis. The belly, too, through the 
whole disease, should be soft and moderately 
distended; but excrements that are very watery, 
or white, or green, or very red, or frothy, are all 
bad. It is also bad when the discharge is small, 
and viscid, and white, and greenish, and smooth ; 
but still more deadly appearances are the black, 
or fatty, or livid, or verdigris-green, or fetid. 
Such as are of varied characters indicate great- 
er duration of the complaint, but are no less 
dangerous; such as those which resemble scrap- 
ings, those which are bilious, those resembling 
leeks, and the black; these being sometimes 
passed together, and sometimes singly. It is best 
when wind passes without noise, but it is better 
that flatulence should pass even thus than that 
it should be retained; and when it docs pass thus, 
it indicates either that the man is in pain or in 
delirium, unless he gives vent to the wind spon- 
taneously. Pains in the hypochondria, and swell- 
ings, if recent, and not accompanied with in- 
flammation, arc relieved by borborygmi super- 



Hippocrates 



vcning in the hypochondrium, more especially 
if it pass off with faeces, urine, and wind; but 
even although not, it will do good by passing 
along, and it also does good by descending to 
the lower part of the belly. 

12. The urine is best when the sediment is 
white, smooth, and consistent during the whole 
time, until the disease come to a crisis, for it in- 
dicates freedom from danger, and an illness of 
short duration; but if deficient, and if it be some- 
times passed clear, and sometimes with a white 
and smooth sediment, the disease will be more 
protracted, and not so void of danger. But if 
the urine be reddish, and the sediment consist- 
ent and smooth, the affection, in this case, will 
be more protracted than the former, but still not 
fatal. But farinaceous sediments in the urine are 
bad, and still worse are the leafy; the white and 
thin are very bad, but the furfuraceous are still 
worse than these. Clouds carried about in the 
urine are good when white, but bad if black. 
When the urine is yellow and thin, it indicates 
that the disease is unconcocted; and if it (the 
disease) should be protracted, there maybe dan- 
ger lest the patient should not hold out until 
the urine be concocted. But the most deadly of 
all kinds of urine are the fetid, watery, black, 
and thick; in adult men and women the black 
isof all kindsof urine the worst, but inchildren, 
the watery. In those who pass thin and crude 
urine fora length of time, if they have otherwise 
symptoms of convalescence, an abscess may be 
expected to form in the parts below the dia- 
phragm. And fatty substances floating on the 
surface are to be dreaded, for they are indica- 
tions ot melting. And one should consider re- 
specting the kinds of urine, which have clouds, 
whether they tend upwards or down wards, and 
the colors which they have and such as fall down- 
wards, with the colors as described, are to be 
reckoned good and commended; but such as are 
carried upwards, with the colors as described, 
are to be held as bad, and are to be distrusted. 
But you must not allow yourself to be deceived 
if such urine be passed while the bladder is dis- 
eased; for then it is a symptom of the state, not 
of the general system, but of a particular viscus. 

13. That vomiting is of most service which 
consists of phlegm and bile mixed together, and 
neither very thick nor in great quantity; but 
those vomitings which are more unmixed are 
worse. But if that which is vomited be of the 
color of leeks or livid, or black, whatever of 
these colors it be, it is to be reckoned bad; but 
if the same man vomit all these colors, it is to be 
reckoned a very fatal symptom. But of all the 



vomitings, the livid indicates the most imminent 
danger of death, provided it be of a fetid smell. 
But all the smells which are somewhat putrid 
and fetid, are bad in all vomitings. 

14. The expectoration in all pains about the 
lungs and sides, should be quickly and easily 
brought up, and a certain degree of yellowness 
should appear strongly mixed up with the spu- 
tum . But if brought up long after the commence- 
ment of the pain, and of a yellow or ruddy color, 
or if it occasions much cough, or be not strong- 
ly mixed, it is worse; for that which is intense- 
ly yellow is dangerous, but the white, and viscid, 
and round, do no good. But that which is very 
green and frothy is bad; but if so intense as to 
appear black, it is still more dangerous than 
these; it is bad if nothing is expectorated, and 
the lungs discharge nothing, but are gorged 
with matters which boil (as it were) in the air- 
passages. It is bad when coryza and sneezing 
either precede or follow affections of the lungs, 
but in all other affections, even the most deadly, 
sneezing is a salutary symptom. A yellow spit- 
tle mixed up with not much blood in cases of 
pneumonia, is salutary and very beneficial if 
spit up at the commencement of the disease, but 
if on the seventh day, or still later, it is less fa- 
vorable. And all sputa are bad which do not re- 
move the pain. But the worst is the black, as has 
been described. Of all others the sputa which 
remove the pain are the best. 

15. When the pains in these regions do not 
cease, either with the discharge of the sputa, nor 
with alvine evacuations, nor from venesection, 
purging with medicine, nor a suitable regimen, 
it is to be held that they will terminate in sup- 
purations. Of empyemata such as are spit up 
while the sputum is still bilious, are very fatal, 
whether the bilious portion be expectorated 
separate, or along with the other; but more es- 
pecially if the empyema begin to advance after 
this sputum on the seventh day of the disease. 
It is to be expected that a person with such an 
expectoration shall die on the fourteenth day, 
unless something favorable supervene. The fol- 
lowing are favorable symptoms: to support the 
disease easily, to have free respiration, to be 
free from pain, to have the sputa readily brought 
up, the whole body to appear equally warm and 
soft, to have no thirst, the urine, and faeces, sleep, 
and sweats to be all favorable, as described be- 
fore; when all these symptoms concur, the pa- 
tient certainly will not die; but if some of these 
be present and some not, he will not survive 
longer than the fourteenth day. The bad symp- 
toms are the opposite of these, namely, to bear 



The Book of Prognostics 



2-3 



the disease with difficulty, respiration large and 
dense, the pain not ceasing, the sputum scarcely 
coughed up, strong thirst, to have the body un- 
equally affected by the febrile heat, the belly 
and sides intensely hot, the forehead, hands, 
and feet cold; the urine, and excrements, the 
sleep, and sweats, all bad, agreeably to the char- 
acters described above; if such a combination of 
symptoms accompany the expectoration, the 
man will certainly die before the fourteenth day, 
and either on the ninth or eleventh. Thus then 
one may conclude regarding this expectoration, 
that it is very deadly, and that the patient will 
not survive until the fourteenth day. It is by 
balancing the concomitant symptoms whether 
good or bad, that one is to form a prognosis; for 
thus it will most probably prove to be a true 
one. Most other suppurations burst, some on 
the twentieth, some on the thirtieth, some on 
the fortieth, and some as late as the sixtieth day. 

1 6. One should estimate when the commence- 
ment of the suppuration will take place, by cal- 
culating from the day on which the patient was 
first seized with fever, or if he had a rigor, and 
if he says, that there is a weight in the place 
where he had pain formerly, for these symp- 
toms occur in the commencement of suppura- 
tions. One then may expect the rupture of the 
abscesses to take place from these times accord- 
ing to the periods formerly stated. But if the 
empyema be only on either side, one should turn 
him and inquire if he has pain on the other side; 
and if the one side be hotter than the other, and 
when laid upon the sound side, one should in- 
quirfe if he has the feeling of a weight hanging 
from above, for if so, the empyema will be upon 
the opposite side to that on which the weight 
was felt. 

17. Empyema may be recognized in all cases 
by the following symptoms: In the first place, 
the fever does not go off, but is slight during the 
day, and increases at night, and copious sweats 
supervene, there is a desire to cough, and the 
patients expectorate nothing worth mentioning, 
the eyes become hollow, the cheeks have red 
spots on them, the nails of the hands are bent, 
the fingers are hot especially their extremities, 
there are swellings in the feet, they have no de- 
sire of food, and small blisters (phlyctaenac) oc- 
cur over the body. These symptoms attend 
chronic empyemata, and may be much trusted 
to; and such as are of short standing are indi- 
cated by the same, provided they be accompa- 
nied by those signs which occur at the commence- 
ment, and if at the same time the patient has 
some difficulty of breathing. Whether they will 



break earlier or later may be. determined by 
these symptoms; if there be pain at the com- 
mencement, and if the dyspnoea, cough, and 
ptyalism be severe, the rupture may be expected 
in the course of twenty days or still earlier; but 
if the pain be more mild, and all the other symp- 
toms in proportion, you may expect from these 
the rupture to be later; but pain, dyspnoea, and 
ptyalism, must take place before the rupture of 
the abscess. Those patients recover most readily 
whom the fever leaves the same day that the ab- 
scess bursts, when they recover their appetite 
speedily, and are freed from the thirst, when 
the alvine discharges are small and consistent, 
the matter white, smooth, uniform in color, and 
free of phlegm, and if brought up without pain 
or strong coughing. Those die whom the fever 
does not leave, or when appearing to leave them 
it returns with an exacerbation; when they have 
thirst, but no desire of food, and there are watery 
discharges from the bowels; when the expecto- 
ration is green or livid, or pituitous and frothy; 
if all these occur they die, but if certain of these 
symptoms supervene, and others not, some pa- 
tients die and some recover, after a long inter- 
val. But from all the symptoms taken together 
one should form a judgment, and so in all other 
cases. 

1 8. When abscesses form about the ears, after 
peripneumonic affections, or depositions of mat- 
ter take place in the inferiorextremitiesand end 
in fistula, such persons recover. The following 
observations arc to be made upon them: if the 
fever persist, and the pain do not cease, if the 
expectoration be not normal, and if the alvine 
discharges be neither bilious, nor free and un- 
mixed; and if the urine be neither copious nor 
have its proper sediment, but if, on the other 
hand, all the other salutary symptoms be pres- 
ent, in such cases abscesses may be expected to 
take place. They form in the inferior parts when 
there is a collection of phlegm about the hypo- 
chondria; and in the upper when the hypochon- 
dria continue soft and free of pain, and when 
dyspnoea having been present for a certain time, 
ceases without any obvious cause. All deposits 
which take place in the legs after severe and 
dangerous attacks of pneumonia, arc salutary, 
but the best are those which occur at the time 
when the sputa undergo a change; for if the 
swelling and pain take place while the sputa are 
changing from yellow and becoming of a puru- 
lent character, and are expectorated freely, un- 
der these circumstances the man will recover 
most favorably and the abscess becoming free 
of pain, will soon cease; but if the expectora- 



Hippocrates 



tion is not free, and the urine does not appear 
to have the proper sediment, there is danger 
lest the limb should be maimed, or that the case 
otherwise should give trouble. But if the ab- 
scesses disappear and go back, while expectora- 
tion does not take place, and fever prevails, it is a 
bad symptom; for there is danger that the man 
may get into a state of delirium and die. Of 
persons having empyema after peripneumonic 
affections, those that are advanced in life run 
the greatest risk of dying; but in the other kinds 
of empyema younger persons rather die. In cases 
of empyema treated by the cautery or incision, 
when the matter is pure, white, and not fetid, 
the patient recovers; but if of a bloody and dirty 
character, he dies. 

19. Pains accompanied with fever which oc- 
cur about the loins and lower parts, if they at- 
tack the diaphragm, and leave the parts below, 
are very fatal. Wherefore one ought to pay at- 
tention to the other symptoms, since if any un- 
favorable one supervene, the case is hopeless; 
but if while the disease is determined to the dia- 
phragm, the other symptoms are not bad, there 
is great reason to expect that it will end in empy- 
ema. When the bladder is hard and painful, it 
is an extremely bad and mortal symptom, more 
especially in cases attended with continued fe- 
ver; for the pains proceeding from the bladder 
alone are enough to kill the patient; and at such 
a time the bowels are not moved, or the dis- 
charges are hard and forced. But urine of a pu- 
rulentcharacter,and havingawhiteand smooth 
sediment, relieves the patient. But if no amend- 
ment takes place in the characters of the urine, 
nor the bladder become soft, and the fever is of 
the continual type, it may be expected that the 
patient will die in the first stages of the com- 
plaint. This form attacks children more espe- 
cially, from their seventh to their fifteenth year. 

20. Fevers come to a crisis on the same days 
as to number on which men recover and die. 
For the mildest class of fevers, and those o- 
riginating with the most favorable symptoms, 
cease on the fourth day or earlier; and the most 
malignant, and those setting in with the most 
dangerous symptoms, prove fatal on the fourth 
clay or earlier. The first class of them as to vio- 
lence ends thus: the second is protracted to the 
seventh day, the third to the eleventh, the fourth 
to the fourteenth, the fifth to the seventeenth, 
and the sixth to the twentieth. Thus these pe- 
riods from the most acute disease ascend by 
fours up to twenty. But none of these can be 
truly calculated by whole days, for neither the 
year nor the months can be numbered by en- 



tire days. After these in the same manner, ac- 
cording to the same progression, the first pe- 
riod is of thirty-four days, the second of forty 
days, and the third of sixty days. In the com- 
mencement of these it is very difficult to deter- 
mine those which will come to a crisis after a 
long interval; for these beginnings are very sim- 
ilar, but one should pay attention from the first 
day, and observe further at every additional tet- 
rad, and then one cannot miss seeing how the dis- 
ease will terminate. The constitution of quartans 
is agreeable to the same order. Those which will 
come to a crisis in the shortest space of time, are 
the easiest to be judged of; for the differences of 
them are greatest from the commencement, 
thus those who are going to recover breathe 
freely, and do not suffer pain, they sleep during 
the night, and have the other salutary symptoms, 
whereas those that are to die have difficult res- 
piration, are delirious, troubled with insomno- 
lency, and have other bad symptoms. Matters 
being thus, one may conjecture, according to 
the time, and each additional period of the dis- 
eases, as they proceed to a crisis. And in wom- 
en, after parturition, the crises proceed agree- 
ably to the same ratio. 

21. Strong and continued headaches with fe- 
ver, if any of the deadly symptoms be joined to 
them, are very fatal. But if without such symp- 
toms the pain be prolonged beyond twenty days, 
a discharge of blood from the nose or some ab- 
scess in the inferior parts may be anticipated; 
but while the pain is recent, we may expect in 
like manner a discharge of blood from the nose, 
or a suppuration, especially if the pain be seat- 
ed above the temples and forehead ; but the hem- 
orrhage is rather to be looked for in persons 
younger than thirty years, and the suppuration 
in more elderly persons. 

22. Acute pain of the ear, with continual and 
strong fever, is to be dreaded; for there is dan- 
ger that the man may become delirious and die. 
Since, then, this is a hazardous spot, one ought 
to pay particular attention to all these symp- 
toms from the commencement. Younger per- 
sons die of this disease on the seventh day, or 
still earlier, but old persons much later; for the 
fevers and delirium less frequently supervene 
upon them, and on that account the ears previ- 
ously come to a suppuration, but at these peri- 
ods of life, relapses of the disease coming on 
generally prove fatal. Younger persons die be- 
fore the ear suppurates; only if white matter 
run from the ear, there may be hope that a 
younger person will recover, provided any oth- 
er favorable symptom be combined. 



The Book of Prognostics 



23. Ulceration of the throat with fever, is a 
serious affection, and if any other of the symp- 
toms formerly described as being bad, be pres- 
ent, the physician ought to announce that his 
patient is in danger. Those quinsies are most 
dangerous, and most quickly prove fatal, which 
make no appearance in the fauces, nor in the 
neck, but occasion very great pain and difficul- 
ty of breathing; these induce suffocation on the 
first day, or on the second, the third, or the 
fourth. Such as, in like manner, are attended 
with pain, are swelled up, and have redness (er- 
ythema) in the throat, are indeed very fatal, but 
more protracted than the former, provided the 
redness be great. Those cases in which both the 
throat and the neck are red, are more protract- 
ed, and certain persons recover from them, es- 
pecially if the neck and breast be affected with 
erythema, and the erysipelas be not determined 
inwardly. If neither the erysipelas disappear on 
the critical day, nor any abscess form outwardly, 
nor any pus be spit up, and if the patient fancy 
himself well, and be free from pain, death, or a 
relapse of the erythema is to be apprehended. It 
is much less hazardous when the swelling and 

redness are determined outwardly; but if de- 
termined to the lungs, they superinduce delir- 
ium, and frequently some of these cases termi- 
nate in empyema. It is very dangerous to cut off 
or scarify enlarged uvulae while they are red and 
large, for inflammations and hemorrhages su- 
pervene; but one should try to reduce such swell- 
ings by some other means at this season. When 
the whole of it is converted into an abscess, 
which is called Uva, or when the extremity of 
the variety called Columellais larger and round, 
but the upper part thinner, at this time it will 
be safe to operate. But it will be better to open 
the bowels gently before proceeding to the op- 
eration, if time will permit, and the patient be 
not in danger of being suffocated. 

24. When the fevers cease without any symp- 
toms of resolution occurring, and not on the 
critical days, in such cases a relapse may be an- 
ticipated. When any of the fevers is protracted, 
although the man exhibits symptoms of recov- 
ery, and there is no longer pain from any inflam- 
mation, nor from any other visible cause, in such 
a case a deposit, with swelling and pain, may be 
expected in some one of the joints, and not im- 
probably in those below. Such deposits occur 
more readily and in less time to persons under 
thirty years of age; and one should immediate- 
ly suspect the formation of such a deposit, if the 
fever be protracted beyond twenty days; but to 
aged persons these less seldom happen, and not 



until the fever be much longer protracted. Such 
a deposit may be expected, when the fever is of 
a continual type, and that it will pass into a 
quartan, if it become intermittent, and its par- 
oxysms come on in an irregular manner, and if 
in this form it approach autumn. As deposits 
form most readily in persons below thirty years 
of age, so quartans most commonly occur to 
persons beyond that age. It is proper to know 
that deposits occur most readily in winter, that 
then they are most protracted, but are less given 
to return. Whoever, in a fever that is not of a 
fatal character, says that he has pain in his head, 
and that something dark appears to be before 
his eyes, and that he has pain at the stomach, 
will be seized with vomiting of bile; but if rigor 
also attack him, and the inferior parts of the hy- 
pochondrium are cold, vomiting is still nearer at 
hand; and if he eat or drink anything at such a 
season, it will be quickly vomited. In thesecases, 
when the pain commences on the first day, they 
are particularly oppressed on the fourth and the 
fifth; and they are relieved on the seventh, but 
the greater part of them begin to have pain on 
the third day, and are most especially tossed on 
the fifth, but are relieved on the ninth or elev- 
enth; but in those who begin to have pains on the 
fifth day, and other matters proceed properly 
with them, the disease comes to a crisis on the 
fourteenth day. But when in such a fever persons 
affected with headache, instead of havingadark 
appearance before theireyes, havedimnessof vi- 
sion, or flashes of light appear before their eyes, 
and instead of pain at the pit of the ^tomach, 
they have in their hypochondrium a fullness 
stretching either to the right or left side, with- 
out either pain or inflammation, a hemorrhage 
from the nose is to be expected in such a case, 
rather than a vomiting. But it is in young per- 
sons particularly that the hemorrhage is to be 
expected, for in persons beyond the age of thirty- 
five, vomitings are rather to be anticipated. Con- 
vulsions occur to children if acute fever be pres- 
ent, and the belly be constipated, if they cannot 
sleep, are agitated, and moan, and change color, 
and become green, livid, or ruddy. These com- 
plaints occur most readily to children which are 
very young up to their seventh year; older chil- 
dren and adults are not equally liable to be 
seized with convulsions in fevers, unless some 
of the strongest and worst symptoms precede, 
such as those which occur in frenzy. One must 
judge of children as of others, which will die 
and which recover, from the whole of the symp- 
toms, as they have been specially described. 
These things I say respecting acute diseases, and 



Hippocrates 



the affections which spring from them. 

25. He who would know correctly beforehand 
those that will recover, and those that will die, 
and in what cases the disease will be protracted 
for many days, and in what cases for a shorter 
time, must be able to form a judgment from 
having made himself acquainted with all the 
symptoms, and estimating their powers in com- 
parison with one another, as has been described, 
with regard to the others, and the urine and 
sputa, as when the patient coughs up pus and 
bile together. One ought also to consider prompt- 
ly the influx of epidemical diseases and the con- 
stitution of the season. One should likewise be 
well acquainted with the particular signs and 
the other symptoms, and not be ignorant how 
that, in every year, and at every season, bad 



symptoms prognosticate ill, and favorable symp- 
toms good, since the aforesaid symptoms appear 
to have held true in Libya, in Delos, and in 
Scythia, 1 from which it may be known that, in 
the same regions, there is no difficulty in attain- 
ing a knowledge of many more things than 
these; if having learned them, one knows also 
how to judge and reason correctly of them. But 
you should not complain because the name of 
any disease may happen not to be described here, 
for you may know all such as come to a crisis in 
the afore-mentioned times, by the same symp- 
toms. 

1 According to Galen, Hippocrates means here 
that good and bad symptoms tell the same in all 
places, in the hot regions of Libya, the cold of 
Scythia, and the temperate of Delos. 



On Regimen in Acute Diseases 



THOSE who composed what are called "The 
Cnidian Sentences" * have described accurately 
what symptoms the sick experience in every 
disease, and how certain of them terminate; 
and in so far a man, even who is not a physician, 
might describe them correctly, provided he put 
the proper inquiries to the sick themselves what 
their complaints are. But those symptoms which 
the physician ought to know beforehand with- 
out being informed of them by the patient, are, 
for the most part, omitted, some in one case and 
some in others, and certain symptoms of vital 
importance for a conjectural judgment. But 
when, in addition to the diagnosis, they de- 
scribe how each complaint should be treated, in 
these cases I entertain a still greater difference of 
opinion with them respecting the rules they have 
laid down; and not only do I not agree with 
them on this account, but also because the rem- 
edies they use are few in number; for, with the 
exception of acute diseases, the only medicines 
which they give are drastic purgatives, with 
whey, and milk at certain times. If, indeed, these 
remedies had been good and suitable to the 
complaints in which they are recommended, 
they would have been still more deserving of 
recommendation, if, while few in number, they 
were sufficient; but this is by no means the case. 
Those, indeed, who have remodeled these "Sen- 
tences" have treated of the remedies applicable 

f The Cnidian Sentences in all probability were 
the results of the observations and theories made 
in the Temple of Health at Cnidos, but they have 
not been preserved. 



in each complaint more in a medical fashion. 
But neither have the ancients written any- 
thing worth mentioning respecting regimen, al- 
though this be a great omission. Some of them, 
indeed, were not ignorant of the many varieties 
of each complaint, and their manifold divisions, 
but when they wish to tell clearly the numbers 
(species?) of each disease they do not write cor- 
rectly; for their species would be almost innu- 
merable if every symptom experienced by the 
patients were held to constitute a disease, and 
receive a different name. 

2. For my part, I approve of paying attention 
to everything relating to the art, and that those 
things which can be done well or properly 
should all be done properly; such as can be 
quickly done should be done quickly; such as 
can be neatly done should be done neatly; such 
operations as can be performed without pain 
should be done with the least possible pain; and 
that all other things of the like kind should be 
done better than they could be managed by the 
attendants. But I would more especially com- 
mend the physician who, in acute diseases, by 
which the bulk of mankind arecut off, conducts 
the treatment better than others. Acute diseases 
are those which the ancients named pleurisy, 
pneumonia, phrenitis, lethargy, causus, and the 
other diseases allied to these, including the con- 
tinual fevers. For, unless when some general 
form of pestilential disease is epidemic, and dis- 
eases are sporadic and [not] of a similar char- 
acter, there are more deaths from these diseases 
than from all the others taken together. The 



On Regimen in Acute Diseases 



vulgar, indeed, do not recognize the difference 
between such physicians and their common at- 
tendants, and are rather disposed to commend 
and censure extraordinary remedies. This, then, 
is a great proof that the common people are 
most incompetent, of themselves, to form a j udg- 
ment how such diseases should be treated: since 
persons who are not physicians pass for physi- 
cians owing most especially to these diseases, for 
it is an easy matter to learn the names of those 
things which are applicable to persons laboring 
under such complaints. For, if one names the 
juice of ptisan, and such and such a wine, and 
hydromel, the vulgar fancy that he prescribes 
exactly the same things as the physicians do, 
both the good and the bad, but in these matters 
there is a great difference between them. 

3. But it appears to me that those things are 
more especially deserving of being consigned 
to writing which are undetermined by physi- 
cians, notwithstanding that they are of vital 
importance, and either do much good or much 
harm. By undetermined I mean such as these, 
wherefore certain physicians, during their whole 
lives, are constantly administering unstrained 
ptisans, and fancy they thus accomplish the cure 
properly, whereas others take great pains that 
the patient should not swallow a particle of the 
barley (thinking it would do much harm), but 
strain the juice through a cloth before giving it; 
others, again, will neither give thick ptisan nor 
the juice, some until the seventh day of the dis- 
ease, and some until after the crisis. Physicians 
are not in the practice of mooting such ques- 
tions; nor, perhaps, if mooted, would a solu- 
tion of them be found; although the whole art 
is thereby exposed to much censure from the 
vulgar, who fancy that there really is no such 
science as medicine, since, in acute diseases, 
practitioners differ so much among themselves, 
that those things which one administers as 
thinking it the best that can be given, another 
holds to be bad; and, in this respect, they might 
say that the art of medicine resembles augury, 
since augurs hold that the same bird (omen) if 
seen on the left hand is good, but if on the right 
bad: and in divination by the inspection of en- 
trails you will find similar differences; but cer- 
tain diviners hold the very opposite of these 
opinions. I say, then, that this question is a 
most excellent one, and allied to very many 
others, some of the most vital importance in the 
Art, for that it can contribute much to the recov- 
ery of the sick, and to the preservation of health 
in the case of those who arc well; and that it 
promotes the strength of those who use gym- 



2-7 

nastic exercises, and is useful to whatever one 
may wish to apply it. 

4. Ptisan, then, appears to me to be justly pre* 
fcrred before all the other preparations from 
grain in these diseases, and I commend those 
who made this choice, 1 for the mucilage of it 
is smooth, consistent, pleasant, lubricant, mod- 
erately diluent, quenches thirst if this be re- 
quired, and has no astringency; gives no trou- 
ble nor swells up in the bowels, for in the boil- 
ing it swells up as much as it naturally can. 
Those, then, who make use of ptisan in such 
diseases, should never for a day allow their ves- 
sels to be empty of it, if I may say so, but should 
use it and not intermit, unless it be necessary 
to stop for a time, in order to administer medi- 
cine or a clyster. And to those who are accus- 
tomed to take two meals in the day it is to be 
given twice, and to those accustomed to live 
upon a single meal it is to be given once at 
first, and then, if the case permit, it is to be in- 
creased and given twice to them, if they appear 
to stand in need of it. At first it will be proper 
not to give a large quantity nor very thick, but 
in proportion to the quantity of food which 
one has been accustomed to take, and so as that 
the veins may not be much emptied. And, with 
regard to the augmentation of the dose, if the 
disease be of a drier nature than one had sup- 
posed, one must not give more of it, but should 
give before the draught of ptisan, either hy< 
dromel or wine, in as great quantity as may be 
proper; and what is proper in each case will be 
afterward stated by us. But if the mouth and the 
passages from the lungs be in a proper state as 
to moisture, the quantity of the draught is to be 
increased, as a general rule, for an early and 
abundant state of moisture indicates an early 
crisis, but a late and deficient moisture indicates 
a slower crisis. And these things are as I have 
stated for the most part; but many other things 
are omitted which are important to the progno- 
sis, as will be explained afterwards. And the 
more that the patient is troubled with purging, 
in so much greater quantity is it to be given un- 
til the crisis, and moreover until two days be- 
yond the crisis, in such cases as it appears to take 
place on the fifth, seventh, or ninth day, so as to 
have respect both for the odd and even day: after 
this the draught is to be given early in the day, 

1 Galen states that, on the principle that diseases 
are to be cured by their contraries, as the essence 
of a febrile disease is combined of heat and dry- 
ness, the indication of a cure is to use means of a 
cooling and moistening nature, and that the ptisan 
fulfils both these objects. 



2,8 Hippocrates 

and the other food in place is to be given in the 
evening. These things are proper, for the most 
part, to be given to those who, from the first, 
have used ptisan containing its whole substance; 
for the pains in pleuritic affections immediately 
cease of their own accord whenever the patients 
begin to expectorate anything worth mention- 
ing, and the purgings become much better, and 
empyema much more seldom takes place, than 
if the patients used a different regimen, and 
the crises are more simple, occur earlier, and the 
cases are less subject to relapses. 

5. Ptisans are to be made of the very best bar- 
ley, and are to be well boiled, more especially 
if you do not intend to use them strained. For, 
besides the other virtues of ptisan, its lubricant 
quality prevents the barley that is swallowed 
from proving injurious, for it does not stick nor 
remain in the region of the breast; for that 
which is well boiled is very lubricant, excellent 
for quenching thirst, of very easy digestion, and 
very weak, all which qualities are wanted. If, 
then, one do not pay proper attention to the 
mode of administering the ptisan, much harm 
may be done; for when the food is shut up in 
the bowels, unless one procure some evacuation 
speedily, before administering the draught, the 
pain, if present, will be exasperated; and, if not 
present, it will be immediately created, and the 
respiration will become more frequent, which 
does mischief, for it dries the lungs, fatigues 
the hypochondria, the hypogastrium, and dia- 
phragm. And moreover if, while the pain of 
the side persists, and does not yield to warm fo- 
mentations, and the sputa are not brought up, 
but are viscid and unconcocted, unless one get 
the pain resolved, either by loosening the bow- 
els, or opening a vein, whichever of these may 
be proper; if to persons so circumstanced pti- 
san be administered, their speedy death will be 
the result. For these reasons, and for others of 
a similar kind still more, those who use un- 
strained ptisan die on the seventh day, or still 
earlier, some being seized with delirium, and 
others dying suffocated with orthopnoee and 
rales. Such persons the ancients thought struct( t 
for this reason more especially, that when dead 
the affected side was livid, like that of a person 
who had been struck. The cause of this is that 
they die before the pain is resolved, being seiz- 
ed with difficulty of respiration, and by large and 
rapid breathing, as has been already explained, 
the spittle becoming thick, acid, and unconcoct- 
ed, cannot be brought up, but, being retained 
in the bronchi of the lungs, produces rales; and, 
when it has come to this, death, for the most 



part, is inevitable; for the sputa being retained 
prevent the breath from being drawn in, and 
force it speedily out, and thus the two conspire 
together to aggravate the mischief; for the sputa 
being retained renders the respiration frequent, 
while the respiration being frequent thickens 
the sputa, and prevents them from being evac- 
uated. These symptoms supervene, not only if 
ptisan be administered unseasonably, but still 
more if any other food or drink worse than 
ptisan be given. 

6. For the most part, then, the results are the 
same, whether the patient have used the un- 
strained ptisan or have used the juice alone; or 
even only drink; and sometimes it is necessary 
to proceed quite differently. In general, one 
should do thus: if fever commences shortly aft- 
er taking food, and before the bowels have been 
evacuated, whether with or without pain, the 
physician ought to withhold the draught until 
he thinks that the food has descended to the 
lower part of the belly; and if any pain be pres- 
ent, the patient should use oxymel, hot if it is 
winter, and cold if it is summer; and, if there 
be much thirst, he should take hydromel and 
water. Then, if any pain be present, or any dan- 
gerous symptoms make their appearance, it will 
be proper to give the draught neither in large 
quantity nor thick, but after the seventh day, if 
the patient be strong. But if the earlier-taken 
food has not descended, in the case of a person 
who has recently swallowed food, and if he be 
strong and in the vigor of life, a clyster should 
be given, or if he be weaker, a suppository is to 
be administered, unless the bowels open proper- 
ly of themselves. The time for administering 
the draught is to be particularly observed at the 
commencement and during the whole illness; 
when, then, the feet are cold, one should refrain 
from giving the ptisan, and more especially ab- 
stain from drink; but when the heat has de- 
scended to the feet, one may then give it; and 
one should look upon this season as of great 
consequence in all diseases, and not least in acute 
diseases, especially those of a febrile character, 
and those of a very dangerous nature. One may 
first use the juice, and then the ptisan, attend- 
ing accurately to the rules formerly laid down. 

7. When pain seizes the side, either at the 
commencement or at a later stage, it will not 
be improper to try to dissolve the pain by hot 
applications. Of hot applications the most pow- 
erful is hot water in a bottle, or bladder, or in a 
brazen vessel, or in an earthen one; but one must 
first apply something soft to the side, to pre- 
vent pain. A soft large sponge, squeezed out of 



On Regimen in Acute Diseases 



hot water and applied, forms a good applica- 
tion; but it should be covered up above, for thus 
the heat will remain the longer, and at the same 
time the vapor will be prevented from being 
carried up to the patient's breath, unless when 
this is thought of use, for sometimes it is the 
case. And further, barley or tares may be infus- 
ed and boiled in diluted vinegar, stronger than 
that it could be drunk, and may then be sewed 
into bladders and applied; and one may use bran 
in like manner. Salts or toasted millet in woolen 
bags are excellent for forming a dry fomenta- 
tion, for the millet is light and soothing. A soft 
fomentation like this soothes pains, even such 
as shoot to the clavicle. Venesection, however, 
does not alleviate the pain unless when it ex- 
tends to the clavicle. But if the pain be not dis- 
solved by the fomentations, one ought not to fo- 
ment for a length of time, for this dries the lungs 
and promotes suppuration; but if the pain point 
to the clavicle, or if there be a heaviness in the 
arm, or about the breast, or above the dia- 
phragm, one should open the inner vein at the 
elbow, and not hesitate to abstract a large quan- 
tity, until it become much redder, or instead 
of being pure red, it turns livid, for both these 
states occur. But if the pain be below the dia- 
phragm, and do not point to the clavicle, we 
must open the belly either with black hellebore 
or peplium, mixing the black hellebore with 
carrot or seseli, or cumin, or anise, or any other 
of the fragrant herbs; and with the peplium 
the juice of sulphium (asafcetida), for these 
substances, when mixed up together, are of a 
similar nature. The black hellebore acts more 
pleasantly and effectually than the peplium, 
while, on the other hand, the peplium expels 
wind much more effectually than the black helle- 
bore, and both these stop the pain, and many 
other of the laxatives also stop it, but these two 
are the most efficacious that I am acquainted 
with. And the laxatives given in draughts are 
beneficial, when not very unpalatable owing 
to bitterness, or any other disagreeable taste, 
or from quantity, color, or any apprehension. 
When the patient has drunk the medicine, one 
ought to give him to swallow but little less of 
the ptisan than what he had been accustomed 
to; but it is according to rule not to give any 
draughts while the medicine is under opera- 
tion; but when the purging is stopped then he 
should take a smaller draught than what he had 
been accustomed to, and afterwards go on in- 
creasing it progressively, until the pain cease, 
provided nothing else contra-indicate. This is 
my rule, also, if one would use the juice of ptis- 



an (for I hold that it is better, on the whole, 
to begin with taking the decoction at once, 
rather than by first emptying the veins before 
doing so, or on the third, fourth, fifth, sixth, or 
seventh day, provided the disease has not pre- 
viously come to a crisis in the course of this 
time), and similar preparations to those for- 
merly described are to be made in those cases. 

8. Such are the opinions which I entertain re- 
specting the administering of the ptisan; and, 
as regards drinks, whichsoever of those about 
to be described may be administered, the same 
directions are generally applicable. And here I 
know that physicians are in the practice of do- 
ing the very reverse of what is proper, for they 
all wish, at the commencement of diseases, to 
starve their patients for two, three, or more 
days, and then to administer the ptisans and 
drinks; and perhaps it appears to them reason- 
able that, as a great change has taken place in 
the body, it should be counteracted by another 
great change. Now, indeed, to produce a change 
is no small matter, but the change must be ef- 
fected well and cautiously, and after the change 
the administration of food must be conducted 
still more so. Those persons, then, would be 
most injured if the change is not properly man- 
aged, who used unstrained ptisans; they also 
would suffer who made use of the juice alone; 
and so also they would suffer who took merely 
drink, but these least of all. 

9. One may derive information from the regi- 
men of persons in good health what things are 
proper; for if it appear that there is a great dif- 
ference whether the diet be so and so, in other 
respects, but more especially in the changes, 
how can it be otherwise in diseases, and more 
especially in the most acute? But it is well as- 
certained that even a faulty diet of food and 
drink steadily persevered in, is safer in the 
main as regards health than if one suddenly 
change it to another. Wherefore, in the case of 
persons who take two meals in the day, or of 
those who take a single meal, sudden changes 
induce suffering and weakness; and thus per- 
sons who have not been accustomed to dine, if 
they shall take dinner, immediately become 
weak, have heaviness over their whole body, 
and become feeble and languid, and if, in ad- 
dition, they take supper, they will have acid 
eructations, and some will have diarrhoea whose 
bowels were previously dry, and not having 
been accustomed to be twice swelled out with 
food and to digest it twice a day, have been 
loaded beyond their wont. It is beneficial, in 
such cases, to counterbalance this change, for 



3 



Hippocrates 



one should sleep after dinner, as if passing the 
night, and guard against cold in winter and 
heat in summer; or, if the person cannot sleep, 
he may stroll about slowly, but without making 
stops, for a good while, take no supper, or, at 
all events, eat little, and only things that are 
not unwholesome, and still more avoid drink, 
and especially water. Such a person will suffer 
still more if he take three full meals in the day, 
and more still if he take more meals; and yet 
there are many persons who readily bear to 
take three full meals in the day, provided they 
arc so accustomed. And, moreover, those who 
have been in the habit of eating twice a day, if 
they omit dinner, become feeble and powerless, 
averse to all work, and have heartburn; their 
bowels seem, as it were, to hang loose, their 
urine is hot and green, and the excrement is 
parched; in some the mouth is bitter, the eyes 
are hollow, the temples throb, and the extremi- 
ties are cold, and the most of those who have 
thus missed their dinner cannot eat supper; or, 
if they do sup, they load their stomach, and pass 
a much worse night than if they had previously 
taken dinner. Since, then, an unwonted change 
of diet for half a day produces such effects up- 
on persons in health, it appears not to be a good 
thing either to add or take from. If, then, he 
who was restricted to a single meal, contrary to 
usage, having his veins thus left empty during 
a whole day, when he supped according to cus- 
tom felt heavy, it is probable that if, because he 
was uneasy and weak from the want of dinner, 
he took a larger supper than wont, he would be 
still more oppressed; or if, wanting food for a 
still greater interval, he suddenly took a meal 
after supper, he will feel still greater oppres- 
sion. He, then, who, contrary to usage, has had 
his veins kept empty by want of food, will find 
it beneficial to counteract the bad effects during 
that day as follows: let him avoid cold, heat, 
and exertion, for he could bear all these ill; let 
him make his supper considerably less than u- 
sual, and not of dry food, but rather liquid; 
and let him take some drink, not of a watery 
character, nor in smaller quantity than is pro- 
portionate to the food, and on the next day he 
should take a small dinner, so that, by degrees, 
he may return to his former practice. Persons 
who are bilious in the stomach bear these changes 
worst, while those who are pituitous, upon the 
whole, bear the want of food best, so that they 
suffer the least from being restricted to one 
meal in the day, contrary to usage. This, then, 
is a sufficient proof that the greatest changes as 
to those things which regard our constitutions 



and habits are most especially concerned in the 
production of diseases, for it is impossible to 
produce unseasonably a great emptying of the 
vessels by abstinence, or to administer food 
while diseases are at their acme, or when in- 
flammation prevails; nor, on the whole, to make 
a great change either one way or another with 
impunity. 

10. One might mention many things akin to 
these respecting the stomach and bowels, to 
show how people readily bear such food as they 
are accustomed to, even if it is not naturally 
good, and drink in like manner, and how they 
bear unpleasantly such food as they are not ac- 
customed to, even although not bad, and so in 
like manner with drink; and as to the effects 
of eating much flesh, contrary to usage, or gar- 
lic, or asafcetida, or the stem of the plant which 
produces it, or things of a similar kind possessed 
of strong properties, one would be less surprised 
if such things produce pains in the bowels, but 
rather when one learned what trouble, swell- 
ing, flatulence, and tormina the cake (maza) 
will raise in the belly when eaten by a person 
not accustomed to it; and how much weight 
and distention of the bowels bread will create 
to a person accustomed to live upon the maza; 
and what thirst and sudden fullness will be 
occasioned by eating hot bread, owing to its 
desiccant and indigestible properties; and what 
different effects arc produced by fine and coarse 
bread when eaten contrary to usage, or by the 
cake when usually dry, moist, or viscid; and 
what different effects polenta produces upon 
those who are accustomed and those who are 
unaccustomed to the use of it; or drinking of 
wine or drinking of water, when either custom 
is suddenly exchanged for the other; or when, 
contrary to usage, diluted wine or undiluted 
has been suddenly drunk, for the one will create 
water-brash in the upper part of the intestinal 
canal and flatulence in the lower, while the other 
will give rise to throbbing of the arteries, heavi- 
ness of the head, and thirst; and white and 
dark-colored wine, although both strong wines, 
if exchanged contrary to usage, will produce 
very different effects upon the body, so that one 
need the less wonder that a sweet and strong 
wine, if suddenly exchanged, should have by 
no means the same effect. 

11. Let us here briefly advert to what may be 
said on the opposite side; namely, that a change 
of diet has occurred in these cases, without any 
change in their body, either as to strength, so 
as to require an increase of food, or as to weak- 
ness, so as to require a diminution. But the 



On Regimen in Acute Diseases 



3 1 



strength of the patient is to be taken into con- 
sideration, and the manner of the disease, and 
of the constitution of the man, and the habitual 
regimen of the patient, not only as regards food 
but also drink. Yet one must much less resort 
to augmentation, since it is often beneficial to 
have recourse to abstraction, when the patient 
can bear it, until the disease having reached its 
acme and has become concocted. But in what 
cases this must be done will be afterwards de- 
scribed. One might write many other things 
akin to those which have been now said, but 
there is a better proof, for it is not akin to the 
matter on which my discourse has principally 
turned, but the subject-matter itself is a most 
seasonable proof. For some at the commence- 
ment of acute diseases have taken food on the 
same day, some on the next day; some have 
swallowed whatever has come in their way, and 
some have taken cyceon? Now all these things 
are worse than if one had observed a different 
regimen; and yet these mistakes, committed at 
that time, do much less injury than if one were 
to abstain entirely from food for the first two 
or three days, and on the fourth or fifth day 
were to take such food; and it would be still 
worse, if one were to observe total abstinence 
for all these days, and on the following days 
were to take such a diet, before the disease is 
concocted; for in this way death would be the 
consequence to most people, unless the disease 
were of a very mild nature. But the mistakes 
committed at first were not so irremediable as 
these, but could be much more easily repaired. 
This, therefore, I think a strong proof that 
such or such a draught need not be prescribed 
on the first days to those who will use the same 
draughts afterwards. At the bottom, therefore, 
they do not know, neither those using un- 
strained ptisans, that they are hurt by them, 
when they begin to swallow them, if they ab- 
stain entirely from food for two, three, or more 
days; nor do those using the juice know that 
they are injured in swallowing them, when they 
do not commence with the draught seasonably. 
But this they guard against, and know that it 
does much mischief, if, before the disease be 
concocted, the patient swallow unstrained ptis- 
an, when accustomed to use strained. All these 
things are strong proofs that physicians do not 
conduct the regimen of patients properly, but 
that in those diseases in which total abstinence 
from food should not be enforced on patients 
1 The cyceon was a mixture of various articles 
of food, but generally contained cheese, honey, 
and wine. 



that will be put on the use of ptisans, they do 
enforce total abstinence; that in those cases in 
which there should be no change made from 
total abstinence to ptisans, they do make the 
change; and that, for the most part, they change 
from abstinence to ptisans, exactly at the time 
when it is often beneficial to proceed from 
ptisans almost to total abstinence, if the disease 
happen to be in the state of exacerbation. And 
sometimes crude matters are attracted from the 
head, and bilious from the region near the 
chest, and the patients are attacked with insom- 
nolency, so that the disease is not concocted; 
they become sorrowful, peevish, and delirious; 
there are flashes of light in their eyes, and 
noises in their ears; their extremities are cold, 
their urine unconcocted; the sputa thin, saltish, 
tinged with an intense color and smell; sweats 
about the neck, and anxiety; respiration, inter- 
rupted in the expulsion of the air, frequent and 
very large; expression of the eyelids dreadful; 
dangerous dcliquia; tossing of the bed-clothes 
from the breast; the hands trembling, and some- 
times the lower lip agitated. These symptoms, 
appearing at the commencement, are indicative 
of strong delirium, and patients so affected gen- 
erally die, or if they escape, it is with a deposit, 
hemorrhage from the nose, or the expectoration 
of thick matter, and not otherwise. Neither do 
I perceive that physicians are skilled in such 
things as these; how they ought to know such 
diseases as are connected with debility, and 
which are further weakened by abstinence from 
food, and those aggravated by some other irri- 
tation; those by pain, and from the acute na- 
ture of the disease, and what affections and 
various forms thereof our constitution and hab- 
it engender, although the knowledge or igno- 
rance of such things brings safety or death to 
the patient. For it is a great mischief if to a 
patient debilitated by pain, and the acute na- 
ture of the disease, one administer drink, or 
more ptisan, or food, supposing that the debil- 
ity proceeds from inanition. It is also disgrace- 
ful not to recognize a patient whose debility is 
connected with inanition, and to pinch him in 
his diet; this mistake, indeed, is attended with 
some danger, but much less than the other, and 
yet it is likely to expose one to much greater de- 
rision, for if another physician, or a private per- 
son, coming in and knowing what has hap- 
pened, should give to eat or drink those things 
which the other had forbidden, the benefit thus 
done to the patient would be manifest. Such 
mistakes of practitioners are particularly ridi- 
culed by mankind, for the physician or non- 



Hippocrates 



professional man thus coming in, seems as it 
were to resuscitate the dead. On this subject I 
will describe elsewhere the symptoms by which 
each of them may be recognized. 

12. And the following observations are simi- 
lar to those now made respecting the bowels. If 
the whole body rest long, contrary to usage, it 
does not immediately recover its strength; but 
if, after a protracted repose, it proceed to labor, 
it will clearly expose its weakness. So it is with 
every one part of the body, for the feet will 
make a similar display, and any other of the 
joints, if, being unaccustomed to labor, they be 
suddenly brought into action, after a time. The 
teeth and the eyes will suffer in like manner, 
and also every other part whatever. A couch, 
also, that is either softer or harder than one has 
betn accustomed to will create uneasiness, and 
sleeping in the open air, contrary to usage, hard- 
ens the body. But it is sufficient merely to state 
examples of all these cases. If a person having 
received a wound in the leg, neither very seri- 
ous nor very trifling, and he being neither in a 
Condition very favorable to its healing nor the 
contrary, at first betakes himself to bed, in or- 
der to promote the cure, and never raises his 
leg, it will thus be much less disposed to in- 
flammation, and be much sooner well, than it 
would have been if he had strolled about dur- 
ing the process of healing; but if upon the fifth 
or sixth day, or even earlier, he should get up 
and attempt to walk, he will suffer much more 
then than if he had walked about from the com- 
mencement of the cure, and if he should sud- 
denly make many laborious exertions, he will 
suffer much more than if, when the treatment 
was conducted otherwise, he had made the same 
exertions on the same days. In fine, all these 
things concur in proving that all great changes, 
either one way or another, are hurtful. Where- 
fore much mischief takes place in the bowels, 
if from a state of great inanition more food than 
is moderate be administered (and also in the 
rest of the body, if from a state of great rest it 
be hastily brought to greater exertion, it will 
be much more injured), or if from the use of 
much food it be changed to complete absti- 
nence, and therefore the body in such cases re- 
quires protracted repose, and if, from a state of 
laborious exertion, the body suddenly falls into 
a state of ease and indolence, in these cases also 
the bowels would require continued repose 
from abundance of food, for otherwise it will 
induce pain and heaviness in the whole body. 

13. The greater part of my discourse has re- 
lated to changes, this way or that. For all pur- 



poses it is profitable to know these things, and 
more especially respecting the subject under 
consideration, that in acute diseases, in which 
a change is made to ptisans from a state of in- 
anition, it should be made as I direct; and then 
that ptisans should not be used until the dis- 
ease be concocted, or some other symptom, 
whether of evacuation or of irritation, appear 
in the intestines, or in the hypochondria, such 
as will be described. Obstinate insomnolency 
impairs the digestion of the food and drink, 
and in other respects changes and relaxes the 
body, and occasions a heated state, and heavi- 
ness of the head. 1 

14. One must determine by such marks as 
these, when sweet, strong, and dark wine, hy- 
dromel, water and oxymel, should be given in 
acute diseases. Wherefore the sweet affects the 
head less than the strong, attacks the brain 
less, evacuates the bowels more than the other, 
but induces swelling of the spleen and liver; 
it does not agree with bilious persons, for it 
causes them to thirst; it creates flatulence in 
the upper part of the intestinal canal, but does 
not disagree with the lower part, as far as re- 
gards flatulence; and yet flatulence engendered 
by sweet wine is not of a transient nature, but 
rests for a long time in the hypochondria. And 
therefore it in general is less diuretic than wine 
which is strong and thin; but sweet wine is 
more expectorant than the other. But when it 
creates thirst, it is less expectorant in such cases 
than the other wine, but if it do not create 
thirst, it promotes expectoration better than the 
other. The good and bad effects of a white, 
strong wine, have been already frequently and 
fully stated in the disquisition on sweet wine; 
it is determined to the bladder more than the 
other, is diuretic and laxative, and should be 
very useful in such complaints; for if in other 
respects it be less suitable than the other, the 
clearing out of the bladder effected by it is 
beneficial to the patient, if properly adminis- 
tered. There are excellent examples of the bene- 
ficial and injurious effects of wine, all which 
were left undetermined by my predecessors. In 
these diseases you may use a yellow wine, and 
a dark austere wine for the following purposes: 
if there be no heaviness of the head, nor deliri- 
um, nor stoppage of the expectoration, nor re- 
tention of the urine, and if the alvine discharg- 
es be more loose and like scrapings than usual, 

1 Galen finds the language in this last sentence 
so confused that he does not hesitate to declare 
that he is convinced the work must have been left 
by Hippocrates in an unfinished state. 



On Regimen in Acute Diseases 



33 



in such cases a change from a white wine to 
such as I have mentioned, might be very prop- 
er. It deserves further to be known, that it will 
prove less injurious to all the parts above, and 
to the bladder, if it be of a more watery nature, 
but that the stronger it is, it will be the more 
beneficial to the bowels. 

15. Hydromel, when drunk in any stage of 
acute disease, is less suitable to persons of a 
bilious temperament, and to those who have 
enlarged viscera, than to those of a different 
character ; it increases thirst less than sweet wine; 
it softens the lungs, is moderately expectorant, 
and alleviates a cough; for it has some deter- 
gent quality in it, whence it lubricates the spu- 
tum. Hydromel is also moderately diuretic, un- 
less prevented by the state of any of the viscera. 
And it also occasions bilious discharges down- 
wards, sometimes of a proper character, and 
sometimes more intense and frothy than is suit- 
able; but such rather occurs in persons who are 
bilious, and have enlarged viscera. Hydromel 
rather produces expectoration, and softening of 
the lungs, when given diluted with water. But 
unmixed hydromel, rather than the diluted, 
produces frothy evacuations, such as are un- 
seasonably and intensely bilious, and too hot; 
but such an evacuation occasions other great 
mischiefs, for it neither extinguishes the heat 
in the hypochondria, but rouses it, induces in- 
quietude, and jactitation of the limbs, and ul- 
cerates the intestines and anus. The remedies 
for all these will be described afterwards. By 
using hydromel without ptisans, instead of any 
other drink, you will generally succeed in the 
treatment of such diseases, and fail in few cases; 
but in what instances it is to be given, and in 
what it is not to be given, and wherefore it is 
not to be given, all this has been explained al- 
ready, for the most part. Hydromel is generally 
condemned, as if it weakened the powers of 
those who drink it, and on that account it is 
supposed to accelerate death; and this opinion 
arose from persons who starve themselves to 
death, some of whom use hydromel alone for 
drink, as fancying that it really has this effect. 
But this is by no means always the case. For 
hydromel, if drunk alone, is much stronger 
than water, if it do not disorder the bowels; but 
in some respects it is stronger, and in some 
weaker, than wine that is thin, weak, and de- 
void of bouquet. There is a great difference be- 
tween unmixed wine and unmixed honey, as 
to their nutritive powers, for if a man will drink 
double the quantity of pure wine, to a certain 
quantity of honey which is swallowed, he will 



find himself much stronger from the honey, 
provided it do not disagree with his bowels, 
and that his alvinc evacuations from it will be 
much more copious. But if he shall use ptisan 
for a draught, and drink afterward hydromel, 
he will feel full, flatulent, and uncomfortable 
in the viscera of the hypochondrium; but if the 
hydromel be taken before the draught, it will 
not have the same injurious effects as if taken 
after it, but will be rather beneficial. And boiled 
hydromel has a much more elegant appearance 
than the unboiled, being clear, thin, white, and 
transparent, but I am unable to mention any 
good quality which it possesses that the other 
wants. For it is not sweeter than the unboiled, 
provided the honey be fine, and it is weaker, 
and occasions less copious evacuations of the 
bowels, neither of which effects is required from 
the hydromel. But one should by all means use 
it boiled, provided the honey be bad, impure, 
black, and not fragrant, for the boiling will re- 
move the most of its bad qualities and appear- 
ances. 

1 6. You will find the drink, called oxymel, 
often very useful in these complaints, for it pro- 
motes expectoration and freedom of breathing, 
the following are the proper occasions for ad- 
ministering it. When strongly acid it has no 
mean operation in rendering the expectoration 
more easy, for by bringing up the sputa, which 
occasion troublesome hawking, and rendering 
them more slippery, and, as it were, clearing 
the windpipe with a feather, it relieves the 
lungs and proves emollient to them; and when 
it succeeds in producing these effects it must do 
much good. But there are cases in which hy- 
dromel, strongly acid, does not promote expec- 
toration, but renders it more viscid and thus 
does harm, and it is most apt to produce these 
bad effects in cases which arc otherwise of a 
fatal character, when the patient is unable to 
cough or bring up the sputa. On this account, 
then, one ought to consider beforehand the 
strength of the patient, and if there be any hope, 
then one may give it, but if given at all in such 
cases it should be quite tepid, and in by no means 
large doses. But if slightly acrid it moistens the 
mouth and throat, promotes expectoration, and 
quenches thirst; agrees with the viscera seated 
in the hypochondrium. and obviates the bad 
effects of the honey; for tne bilious quality of the 
honey is thereby corrected. It also promotes 
flatulent discharges from the bowels, and is 
diuretic, but it occasions watery discharges and 
those resembling scrapings, from the lower part 
of the intestine, which is sometimes a bad thing 



34 

in acute diseases, more especially when the flat- 
ulence cannot be passed, but rolls backwards; 
and otherwise it diminishes the strength and 
makes the extremities cold, this is the only bad 
effect worth mentioning which I have known 
to arise from the oxymel. It may suit well to 
drink a little of this at night before the draught 
of ptisan, and when a considerable interval of 
time has passed after the draught there will be 
nothing to prevent its being taken. But to those 
who are restricted entirely to drinks without 
draughts of ptisan, it will therefore not be prop- 
er at all times to give it, more especially from 
the fretting and irritation of the intestine which 
it occasions, (and these bad effects it will be the 
more apt to produce provided there be no faeces 
in the intestines and the patient is laboring un- 
der inanition,) and then it will weaken the 
powers of the hydromel. But if it appears ad- 
vantageous to use a great deal of this drink dur- 
ing the whole course of the disease, one should 
add to it merely as much vinegar as can just 
be perceived by the taste, for thus what is prej- 
udicial in it will do the least possible harm, 
and what is beneficial will do the more good. 
In a word, the acidity of vinegar agrees rather 
with those who are troubled with bitter bile, 
than with those patients whose bile is black; for 
the bitter principle is dissolved in it and turned 
to phlegm, by being suspended in it; whereas 
black bile is fermented, swells up, and is mul- 
tiplied thereby: for vinegar is a melanogogue. 
Vinegar is more prejudicial to women than to 
men, for it creates pains in the uterus. 

17. I have nothing further to add as to the 
effects of water when used as a drink in acute 
diseases; for it neither soothes the cough in 
pneumonia, nor promotes expectoration, but 
does less than the others in this respect, if used 
alone through the whole complaint. But if tak- 
en intermediate between oxymel and hydro- 
mel, in small quantity, it promotes expectora- 
tion from the change which it occasions in the 
qualities of these drinks, for it produces, as it 
were, a certain overflow. Otherwise it does not 
quench the thirst, for it creates bile in a bilious 
temperament, and is injurious to the hypochon- 
drium; and it does the most harm, engenders 
most bile, and does the least good when the 
bowels arc empty; and it increases the swelling 
of the spleen and liver when they are in an in- 
flamed state; it produces a gurgling noise in 
the intestines and swims on the stomach; for it 
passes slowly downwards, as being of a coldish 
and indigestible nature, and neither proves lax- 
ative nor diuretic; and in this respect, too, it 



Hippocrates 

proves prejudicial, that it does not naturally 
form faeces in the intestines: and, if it be drunk 
while the feet are cold, its injurious effects will 
be greatly aggravated, in all those parts to which 
it may be determined. When you suspect in 
these diseases either strong heaviness of the 
head, or mental alienation, you must abstain 
entirely from wine, and in this case use water, 
or give weak, straw-colored wine, entirely de- 
void of bouquet, after which a little water is to 
be given in addition; for thus the strength of 
the wine will less affect the head and the under- 
standing: but in which cases water is mostly to 
be given for drink, when in large quantity, 
when in moderate, when cold, and when hot; 
all these things have either been discussed al- 
ready or will be treated of at the proper time. 
In like manner, with respect to all the others, 
such as barley-water, the drinks made from 
green shoots, those from raisins, and the skins 
of grapes and wheat, and bastard saffron, and 
myrtles, pomegranates, and the others, when 
the proper time for using them is come, they 
will be treated of along with the disease in ques- 
tion, in like manner as the other compound 
medicines. 

1 8. The bath is useful in many diseases, in 
some of them when used steadily, and in others 
when not so. Sometimes it must be less used 
than it would be otherwise, from the want of 
accommodation; for in few families are all the 
conveniences prepared, and persons who can 
manage them as they ought to be. And if the 
patient be not bathed properly, he may be there- 
by hurt in no inconsiderable degree, for there 
is required a place to cover him that is free of 
smoke, abundance of water, materials for fre- 
quent baths, but not very large, unless this 
should be required. It is better that no friction 
should be applied, but if so, a hot soap (smeg- 
ma) must be used in greater abundance than is 
common, and an affusion of a considerable 
quantity of water is to be made at the same time 
and afterwards repeated. There must also be a 
short passage to the basin, and it should be of 
easy ingress and egress. But the person who 
takes the bath should be orderly and reserved 
in his manner, should do nothing for himself, 
but others should pour the water upon him and 
rub him, and plenty of waters, of various tem- 
peratures, should be in readiness for the douche, 
and the affusions quickly made; and sponges 
should be used instead of the comb (strigil), 
and the body should be anointed when not 
quite dry. But the head should be rubbed by 
the sponge until it is quite dry; the extremities 



On Regimen in Acute Diseases 



35 



should be protected from cold, as also the head 
and the rest of the body; and a man should not 
be washed immediately after he has taken a 
draught of ptisan or a drink; neither should he 
take ptisan as a drink immediately after the 
bath. Much will depend upon whether the pa- 
tient, when in good health, was very fond of the 
bath, and in the custom of taking it: for such 
persons, especially, feel the want of it, and are 
benefited if they are bathed, and injured if they 
are not. In general it suits better with cases of 
pneumonia than in ardent fevers; for the bath 
soothes the pain in the side, chest, and back; 
concocts the sputa, promotes expectoration, im- 
proves the respiration, and allays lassitude; for 
it soothes the joints and outer skin, and is diu- 
retic, removes heaviness of the head, and mois- 
tens the nose. Such are the benefits to be derived 
from the bath, if all the proper requisites be 
present; but if one or more of these be wanting, 
the bath, instead of doing good, may rather 
prove injurious; for every one of them may do 
harm if not prepared by the attendants in the 
proper manner. It is by no means a suitable 
thing in these diseases to persons whose bowels 
are too loose, or when they are unusually con- 
fined, and there has been no previous evacua- 
tion; neither must we bathe those who are de- 
bilitated, nor such as have nausea or vomiting, 
or bilious eructations; nor such as have hemor- 
rhage from the nose, unless it be less than re- 
quired at that stage of the disease (with those 
stages you are acquainted), but if the discharge 
be less than proper, one should use the bath, 
whether in order to benefit the whole body or 
the head alone. If then the proper requisites be 
at hand, and the patient be well disposed to the 
bath, it may be administered once every day, or 
if the patient be fond of the bath there will be 
no harm, though he should take it twice in the 
day. The use of the bath is much more appro- 
priate to those who take unstrained ptisan, than 
to those who take only the juice of it, although 
even in their case it may be proper; but least of 
all does it suit with those who use only plain 
drink, although, in their case too it may be 
suitable; but one must form a judgment from 
the rules laid down before, in which of these 
modes of regimen the bath will be beneficial, 
and in which not. Such as want some of the req- 
uisites for a proper bath, but have those symp- 
toms which would be benefited by it, should be 
bathed; whereas those who want none of the 
proper requisites, but have certain symptoms 
which contraindicate the bath, are not to be 
bathed. 



APPENDIX 



Ardent fever (causus) takes place when the 
veins, being dried up in the summer season, at- 
tract acrid and bilious humors to themselves; 
and strong fever seizes the whole body, which 
experiences aches of the bones, and is in a 
state of lassitude and pain, li takes place most 
commonly from a long walk and protracted 
thirst, when the veins being dried up attract 
acrid and hot defluxions to themselves. The 
tongue becomes rough, dry, and very black; 
there are gnawing pains about the bowels; the 
alvine discharges are watery and yellow; there 
is intense thirst, insomnolency, and sometimes 
wandering of the mind. To a person in such a 
state give to drink water and as much boiled 
hydromel of a watery consistence as he will 
take; and if the mouth be bitter, it may be ad- 
vantageous to administer an emetic and clyster; 
and if these things do not loosen the bowels, 
purge with the boiled milk of asses. Give noth- 
ing saltish nor acrid, for they will not be borne; 
and give no draughts of ptisan until the crisis 
be past. And the affection is resolved if there be 
an epistaxis, or if true critical sweats supervene 
with urine having white, thick, and smooth 
sediments, or if a deposit take place anywhere; 
but if it be resolved without these, there will be 
a relapse of the complaint, or pain in the hips 
and legs will ensue, with thick sputa, provided 
the patient be convalescent. Another species of 
ardent fever: belly loose, much thirst, tongue 
rough, dry, and saltish, retention of urine, in- 
somnolency, extremities cold. In such a case, un- 
less there be a flow of blood from the nose, or 
an abscess form about the neck, or pain in the 
limbs, or the patient expectorate thick sputa 
(these occur when the belly is constipated), or 
pain of the hips, or lividity of the genital or- 
gans, there is no crisis; tension of the testicle is al- 
so a critical symptom. Give attractive draughts. 

2. Bleed in the acute affections, if the disease 
appear strong, and the patients be in the vigor 
of life, and if they have strength. If it be quinsy 
or any other of the pleuritic affections, purge 
with electuaries; but if the patient be weaker, 
or if you abstract more blood, you may admin- 
ister a clyster every third day, until he be out 
of danger, and enjoin total abstinence if neces- 
sary. 

3. Hypochondria inflamed not from reten- 
tion of flatus, tension of the diaphragm, checked 
respiration, with dry orthopnoea, when no pus 
is formed, but when these complaints are con- 
nected with obstructed respiration; but more 
especially strong pains of the liver, heaviness of 



36 

the spleen, and other phlegmasiae and intense 
pains above the diaphragm, diseases connected 
with collections of humors, all these diseases 
do not admit of resolution, if treated at first by 
medicine, but venesection holds the first place 
in conducting the treatment; then we may have 
recourse to a clyster, unless the disease be great 
and strong; but if so, purging also may be nec- 
essary; but bleeding and purging together re- 
quire caution and moderation. Those who at- 
tempt to resolve inflammatory diseases at the 
commencement by the administration of pur- 
gative medicines, remove none of the morbific 
humors which produce the inflammation and 
tension; for the diseases while unconcocted 
could not yield, but they melt down those parts 
which are healthy and resist the disease; so 
when the body is debilitated the malady ob- 
tains the mastery; and when the disease has the 
upper hand of the body, it does not admit of a 
cure. 

4. When a person suddenly loses his speech, 
in connection with obstruction of the veins, 
if this happen without warning or any other 
strong cause, one ought to open the internal vein 
of the right arm, and abstract blood more or 
less according to the habit and age of the pa- 
tient. Such cases are mostly attended with the 
following symptoms: redness of the face, eyes 
fixed, hands distended, grinding of the teeth, 
palpitations, jaws fixed, coldness of the extrem- 
ities, retention of airs in the veins. 

5. When pains precede, and there are influxes 
of black bile and of acrid humors, and when 
by their pungency the internal parts are pained, 
and the veins being pinched and dried become 
distended, and getting inflamed attract the hu- 
mors running into the parts, whence the blood 
being vitiated, and the airs collected there not 
being able to find their natural passages, cold- 
ness comes on in consequence of this stasis, 
with vertigo, loss of speech, heaviness of the 
head, and convulsion, if the disease fix on the 
liver, the heart, or the great vein (vena cava? ) ; 
whence they are seized with epilepsy or apo- 
plexy, if the defluxions fall upon the containing 
parts, and if they are dried up by airs which 
cannot make their escape; such persons having 
been first fomented are to be immediately bled 
at the commencement, while all the peccant 
vapors and humors are buoyant, for then the 
cases more easily admit of a cure; and then sup- 
porting the strength and attending to the crisis, 
we may give emetics, unless the disease be al- 
leviated; or if the bowels be not moved, we may 
administer a clyster and give the boiled milk 



Hippocrates 

of asses, to the amount of not less than twelve 
heminae, or if the strength permit, to more than 
sixteen. 

6. Quinsy takes place when a copious and 
viscid defluxion from the head, in the season of 
winter or spring, flows into the jugular veins, 
and when from their large size they attract a 
greater defluxion; and when owing to the de- 
fluxion being of a cold and viscid nature it be- 
comes enfarcted, obstructing the passages of 
the respiration and of the blood, coagulates the 
surrounding blood, and renders it motionless 
and stationary, it being naturally cold and dis- 
posed to obstructions. Hence they are seized 
with convulsive suffocation, the tongue turn- 
ing livid, assuming a rounded shape, and being 
vent owing to the veins which are seated below 
the tongue (for when an enlarged uvula, which 
is called uva, is cut, a large vein may be ob- 
served on each side). These veins, then, be- 
coming filled, and their roots extending into 
the tongue, which is of a loose and spongy tex- 
ture, it, owing to its dryness receiving forcibly 
the juice from the veins, changes from broad 
and becomes round, its natural color turns to 
livid, from a soft consistence it grows hard, in- 
stead of being flexible it becomes inflexible, so 
that the patient would soon be suffocated un- 
less speedily relieved. Bleeding, then, in the 
arm, and opening the sublingual veins, and 
purging with the electuaries, and giving warm 
gargles, and shaving the head, we must apply 
to it and the neck a cerate, and wrap them 
round with wool, and foment with soft sponges 
squeezed out of hot water; give to drink water 
and hydromel, not cold; and administer the 
juice of ptisan when, having passed the crisis, 
the patient is out of danger. When, in the sea- 
son of summer or autumn, there is a hot and 
nitrous defluxion from the head (it is rendered 
hot and acrid by the season), being of such a 
nature it corrodes and ulcerates, and fills with 
air, and orthopncea attended with great dry- 
ness supervenes; the fauces, when examined, 
do not seem swollen; the tendons on the back 
part of the neck are contracted, and have the 
appearance as if it were tetanus; the voice is 
lost, the breathing is small, and inspiration be- 
comes frequent and laborious. In such persons 
the trachea becomes ulcerated, and the lungs 
engorged, from the patient's not being able to 
draw in the external air. In such cases, unless 
there be a spontaneous determination to the ex- 
ternal parts of the neck, the symptoms become 
still more dreadful, and the danger more im- 
minent, partly owing to the season, and the hot 



On Regimen in Acute Diseases 



37 



and acrid humors which cause the disease. 

7. When fever seizes a person who has lately 
taken food, and whose bowels are loaded with 
faeces which have been long retained, whether 
it be attended with pain of the side or not, he 
ought to lie quiet until the food descend to the 
lower region of the bowels, and use oxymel for 
drink; but when the load descends to the loins, 
a clyster should be administered, or he should 
be purged by medicine; and when purged, he 
should take ptisan for food and hydromel for 
drink; then he may take the cereal ia, and boiled 
fishes, and a watery wine in small quantity, at 
night, but during the day, a watery hydromel. 
When the flatus is offensive, either a supposi- 
tory or clyster is to be administered; but other- 
wise the oxymel is to be discontinued, until the 
matters descend to the lower part of the bowels, 
and then they are to be evacuated by a clyster. 
But if the ardent fever (causus) supervene 
when the bowels are empty, should you still 
judge it proper to administer purgative medi- 
cine, it ought not be done during the first three 
days, nor earlier than the fourth. When you 
give the medicine, use the ptisan, observing the 
paroxysms of the fevers, so as not to give it 
when the fever is setting in, but when it is 
ceasing, or on the decline, and as far as possible 
from the commencement. When the feet are 
cold, give neither drink nor ptisan, nor any- 
thing else of the kind, but reckon it an impor- 
tant rule to refrain until they become warm, 
and then you may administer them with ad- 
vantage. For the most part, coldness of the feet 
is a symptom of a paroxysm of the fever com- 
ing on; and if at such a season you apply those 
things, you will commit the greatest possible 
mistake, for you will augment the disease in no 
small degree. But when the fever ceases, the 
feet, on the contrary, become hotter than the 
rest of the body; for when the heat leaves the 
feet, it is kindled up in the breast, and sends its 
flame up to the head. And when all the heat 
rushes upwards, and is exhaled at the head, it 
is not to be wondered at that the feet become 
cold, being devoid of flesh, and tendinous; and 
besides, they contract cold, owing to their dis- 
tance from the hotter parts of the body, an ac- 
cumulation of heat having taken place in the 
chest: and again, in like manner, when the fe- 
yer is resolved and dissipated, the heat descends 
to the feet, and, at the same time, the head and 
chest become cold. Wherefore one should at- 
tend to this; that when the feet are cold, the 
bowels are necessarily hot, and filled with nau- 
seous matters; the hypochondrium distended: 



there is jactitation of the body, owing to the 
internal disturbance; and aberration of the in- 
tellect, and pains; the patient is agitated, and 
wishes to vomit, and if he vomits bad matters 
he is pained; but when the heat descends to the 
feet, and the urine passes freely, he is every 
way lightened, even although he does not sweat; 
at this season, then, the ptisan ought to be giv- 
en; it would be death to give it before. 

8. When the bowels are loose during the 
whole course of fevers, in this case we are most 
especially to warm the feet, and see that they 
are properly treated with cerates, and wrapped 
in shawls, so that they may not become colder 
than the rest of the body; but when they are 
hot, no fomentation must be made to them, but 
care is to be taken that they do not become cold; 
and very little drink is to be used, either cold 
water or hydromel. In those cases of fever where 
the bowels are loose, and the mind is disorder- 
ed, the greater number of patients pick the wool 
from their blankets, scratch their noses, answer 
briefly when questions are put to them, but, 
when left to themselves, utter nothing that is 
rational. Such attacks appear to me to be con- 
nected with black bile. When in these cases 
there is a colliquative diarrhoea, I am of opin- 
ion that we ought to give the colder and thicker 
ptisans, and that the drinks ought to be bind- 
ing, of a vinous nature, and rather astringent. 
In cases of fever attended from the first with 
vertigo, throbbing of the head, and thin urine, 
you may expect the fever to be exacerbated at 
the crisis; neither need it excite wonder, al- 
though there be delirium. When, at the com- 
mencement, the urine is cloudy or thick, it is 
proper to purge gently, provided this be other- 
wise proper; but when the urine at first is thin, 
do not purge such patients, but, if thought nec- 
essary, give a clyster; such patients should be 
thus treated; they should be kept in a quiet state, 
have unguents applied to them, and be covered 
up properly with clothes, and they should use 
for drink a watery hydromel, and the juice of 
ptisan as a draught in the evening; clear out the 
bowels at first with a clyster, but give no purga- 
tive medicines to them, for, if you move the 
bowels strongly, the urine is not concocted, but 
the fever remains long, without sweats and 
without a crisis. Do not give draughts when 
the time of the crisis is at hand, if there be agita- 
tion, but only when the fever abates and is alle- 
viated. It is proper to be guarded at the crises of 
other fevers, a,nd to withhold the draughts at 
that season. Fevers of this description are apt 
to be protracted, and to have determinations, 



Hippocrates 



if the inferior extremities be cold, about the ears 
and neck, or, if these parts are not cold, to have 
other changes; they have cpistaxis,and disorder 
of the bowels. But in cases of fever attended 
with nausea, or distention of the hypochondria, 
when the patients cannot lie reclined in the same 
position, and the extremities are cold, the great- 
est care and precaution are necessary; nothing 
should be given to them, except oxymel diluted 
with water; no draught should be administered, 
until the fever abate and the urine be concocted; 
the patient should be laid in a dark apartment, 
and recline upon the softest couch, and he 
should be kept as long as possible in the same 
position, so as not to toss about, for this is par- 
ticularly beneficial to him. Apply to the hypo- 
chondrium linseed by inunctions, taking care 
that he do not catch cold when the application 
is made; let it be in a tepid state, and boiled in 
water and oil. One may judge from the urine 
what is to take place, for if the urine be thicker, 
and more yellowish, so much the better; but if 
it be thinner, and blacker, so much the worse; 
but if it undergo changes, it indicates a prolon- 
gation of the disease, and the patient, in like 
manner, must experience a change to the worse 
and the better. Irregular fevers should be let 
alone until they become settled, and, when they 
do settle, they are to be treated by a suitable 
diet and medicine, attending to the constitu- 
tion of the patient. 

9. The aspects of the sick are various; where- 
fore the physician should pay attention, that he 
may not miss observing the exciting causes, as 
far as they can be ascertained by reasoning, nor 
such symptoms as should appear on an even or 
odd day, but he ought to be particularly guard- 
ed in observing the odd days, as it is in them, 
more especially, that changes take place in pa- 
tients. He should mark, particularly, the first 
day on which the patient became ill, consider- 
ing when and whence the disease commenced, 
for this is of primary importance to know. 
When you examine the patient, inquire into 
all particulars; first how the head is, and if 
there be no headache, nor heaviness in it; then 
examine if the hypochondria and sides be free of 
pain; for if the hypochondrium be painful, 
swelled, and unequal, with a sense of satiety, or 
if there be pain in the side, and, along with the 
pain, cither cough, tormina, or belly-ache, if any 
of these symptoms be present in the hypochon- 
drium, the bowels should be opened with clys- 
ters, and the patient should drink boiled hydro- 
mel in a hot state. The physician should ascer- 
tain whether the patient be apt to faint when he is 



raised up, and whether his breathing be free; 
and examine the discharges from the bowels, 
whether they be very black, or of a proper color, 
like those of persons in good health, and ascer- 
tain whether the fever has a paroxysm every 
third day, and look well to such persons on 
those days. And should the fourth day prove 
like the third, the patient is in a dangerous state. 
With regard to the symptoms, black stools prog- 
nosticate death; but if they resemble the dis- 
charges of a healthy person, and if such is their 
appearance every day, it is a favorable symp- 
tom; but when the bowels do not yield to a sup- 
pository, and when, though the respiration be 
natural, the patient when raised to the night- 
table, or even in bed, be seized with deliquium, 
you may expect that the patient, man or woman, 
who experiences these symptoms, is about to 
fall into a state of delirium. Attention also should 
be paid to the hands, for if they tremble, you 
may expect epistaxis; and observe the nostrils, 
whether the breath be drawn in equally by both; 
and if expiration by the nostrils be large, a con- 
vulsion is apt to take place; and should a con- 
vulsion occur to such a person, death may be 
anticipated, and it is well to announce it before- 
hand. 

10. If, in a winter fever, the tongue be rough, 
and if there be swoonings, it is likely to be the 
remission of the fever. Nevertheless such a per- 
son is to be kept upon a restricted diet, with 
water for drink, and hydromel, and the strain- 
ed juices, not trusting to the remission of the 
fevers, as persons having these symptoms are 
in danger of dying; when, therefore, you per- 
ceive these symptoms, announce this prognos- 
tic, if you shall judge proper, after making the 
suitable observations. When, in fevers, any dan- 
gerous symptom appears on the fifth day, when 
watery discharges suddenly take place from the 
bowels, when deliquium animi occurs, or the 
patient is attacked with loss of speech, convul- 
sions, or hiccup, under such circumstances he 
is likely to be affected with nausea, and sweats 
break out under the nose and forehead, or on 
the back part of the neck and head, and patients 
with such symptoms shortly die, from stoppage 
of the respiration. When, in fevers, abscesses 
form about the legs, and, getting into a chronic 
state, are not concocted while the fever persists, 
and if one is seized with a sense of suffocation 
in the throat, while the fauces are not swelled, 
and if it do not come to maturation, but is re- 
pressed, in such a case there is apt to be a flow 
of blood from the nose; if this, then, be copious, 
it indicates a resolution of the disease, but if not, 



On Regimen in Acute Diseases 



a prolongation of the complaint; and the less 
the discharge, so much worse the symptoms, 
and the more protracted the disease; but if the 
other symptoms are very favorable, expect in 
such a case that pains will fall upon the feet; if 
then they attack the feet, and if these continue 
long in a very painful, and inflamed state, and 
if there be no resolution, the pains will extend 
by degrees to the neck, to the clavicle, shoulder, 
breast, or to some articulation, in which an in- 
flammatory tumor will necessarily form. When 
these arc reduced, if the hands are contracted, 
and become trembling, convulsion and delirium 
seize such a person; but blisters break out on 
the eyebrow, erythema takes place, the one eye- 
lid being tumefied overtops the other, a hard 
inflammation sets in, the eye become strongly 
swelled, and the delirium increases much, but 
makes its attacks rather at night than by day. 
These symptoms more frequently occur on odd 
than on even days, but, whether on the one or 
the other, they are of a fatal character. Should 
you determine to give purgative medicines in 
such cases, at the commencement, you should 
do so before the fifth day, if there be borborygmi 
in the bowels, or, if not, you should omit the 
medicines altogether. If there be borborygmi, 
with bilious stools, purge moderately with scam- 
mony; but with regard to the treatment other- 
wise, administer as few drinks and draughts 
as possible, until there be some amendment, 
and the disease is past the fourteenth day. When 
loss of speech seizes a person, on the fourteenth 
day of a fever, there is not usually a speedy reso- 
lution, nor any removal of the disease, for this 
symptom indicates a protracted disease; and 
when it appears on that day, it will be still more 
prolonged. When, on the fourth day of a fever, 
the tongue articulates confusedly, and when 
there are watery and bilious discharges from 
the bowels, such a patient is apt to fall into a 
state of delirium; the physician ought, there- 
fore, to watch him, and attend to whatever 
symptoms may turn up. In the season of sum- 
mer and autumn an epistaxis, suddenly occur- 
ring in acute diseases, indicates vehemence of 
the attack, and inflammation in the course of 
the veins, and on the day following, the dis- 
charge of thin urine; and if the patient be in 
the prime of life, and if his body be strong from 
exercise, and brawny, or of a melancholic tem- 
perament, or if from drinking he has trembling 
hands, it may be well to announce beforehand 
either delirium or convulsion; and if these 
symptoms occur on even days, so much the bet- 
ter; but on critical days, they are of a deadly 



39 

character. If, then, a copious discharge of blood 
procure an issue to the fullness thereof about 
the nose, or what is collected about the anus, 
there will be an abscess, or pains in the hypo- 
chondrium, or testicles, or in the limbs; and 
when these are resolved, there will be a dis- 
charge of thick sputa, and of smooth, thin urine. 
In fever attended with singultus, give asafcetida, 
oxymel, and carrot, triturated together, in a 
draught; or galbanum in honey, and cumin in 
a linctus, or the juice of ptisan. Such a person 
cannot escape, unless critical sweats and gentle 
sleep supervene, and thick and acrid urine be 
passed, or the disease terminate in an abscess: 
give pine-fruit and myrrh in a linctus, and fur- 
ther give a very little oxymel to drink; but if 
they are very thirsty, some barley-water. 

u. Peripneumonia, and pleuritic affections, 
are to be thus observed: If the fever be acute, 
and if there be pains on either side, or in both, 
and if expiration be attended with pain, if cough 
be present, and the sputa expectorated be of a 
blond or livid color, or likewise thin, frothy, and 
florid, or having any other character different 
from the common, in such a case, the physician 
should proceed thus: if the pain pass upward to 
the clavicle, or the breast, or the arm, the inner 
vein in the arm should be opened on the side 
affected, and blood abstracted according to the 
habit, age, and color of the patient, and the sea- 
son of the year, and that largely and boldly, if 
the pain be acute, so as to bring on deliquium 
animi, and afterwards a clyster is to be given. 
But if the pain be below the chest, and if very 
intense, purge the bowels gently in such an at- 
tack of pleurisy, and during the act of purging 
give nothing; but after the purging give oxymel 
The medicine is to be administered on the 
fourth day; on the first three days after the 
commencement, a clyster should be given, and 
if it does not relieve the patient, he should then 
be gently purged, but he is to be watched until 
the fever goes off, and till the seventh day; then 
if he appear to be free from danger, give him 
some unstrained ptisan, in small quantity, and 
thin at first, mixing it with honey. If the expec- 
toration be easy, and the breathing free, if his 
sides be free of pain, and if the fever be gone, 
he may take the ptisan thicker, and in larger 
quantity, twice a day. But if he do not progress 
favorably, he must get less of the drink, and of 
the draught, which should be thin, and only 
given once a day, at whatever is judged to be 
the most favorable hour; this you will ascertain 
from the urine. The draught is not to be given 
to persons after fever, until you see that the 



Hippocrates 



urine and sputa are concocted (if, indeed, after 
the administration of the medicine he be 
purged frequently, it may be necessary to give 
it, but it should be given in smaller quantities 
and thinner than usual, for from inanition he 
will be unable to sleep, or digest properly, or wait 
the crisis); but when the melting down of crude 
matters has taken place, and his system has cast 
off what is offensive, there will then be no objec- 
tion. The sputa are concocted when they resem- 
ble pus, and the urine when it has reddish sedi- 
ments like tares. But there is nothing to prevent 
fomentations and cerates being applied for the 
other pains of the sides; and the legs and loins 
may be rubbed with hot oil, or anointed with 
fat; linseed, too, in the form of a cataplasm, may 
be applied to the hypochondrium and as far up 
as the breasts. When pneumonia is at its height, 
the case is beyond remedy if he is not purged, 
and it is bad if he has dyspnoea, and urine that 
is thin and acrid, and if sweats come out about 
the neck and head, for such sweats are bad, as 
proceeding from the suffocation, rdles, and the 
violence of the disease which is obtaining the 
upper hand, unless there be a copious evacua- 
tion of thick urine, and the sputa be concocted; 
when either of these come on spontaneously, 
that will carry off the disease. A linctus for 
pneumonia: Galbanum and pine-fruit in Attic 
honey; and southernwood in oxymel; make a 
decoction of pepper and black hellebore, and 
give it in cases of pleurisy attended with violent 
pain at the commencement. It is also a good 
thing to boil opoponax in oxymel, and, having 
strained it, to give it to drink; it answers well, 
also, in diseases of the liver, and in severe pains 
proceeding from the diaphragm, and in all 
cases in which it is beneficial to determine to 
the bowels or urinary organs, when given in 
wine and honey; when given to act upon the 
bowels, it should be drunk in larger quantity, 
along with a watery hydromel. 

12. A dysentery, when stopped, will give rise 
to an aposteme, or tumor, if it do not terminate 
in fevers with sweats, or with thick and white 
urine, or in a tertian fever, or the pain fix upon 
a varix, or the testicles, or on the hip-joints. 

13. In a bilious fever, jaundice coming on with 
rigor before the seventh day carries off the fever, 
but if it occur without the fever, and not at the 
proper time, it is a fatal symptom. 

14. When the loins are in a tetanic state, and 
the spirits in the veins are obstructed by melan- 
cholic humors, venesection will afford relief. 
But when, on the other hand, the anterior ten- 
dons are strongly contracted, and if there be 



sweats about the neck and face, extorted by the 
violent pain of the parched and dried tendons 
of the sacral extremity (these are very thick, 
sustaining the spine, and giving rise to very 
great ligaments, which terminate in the feet,) in 
such a case, unless fever and sleep come on, fol- 
lowed by concocted urine and critical sweats, 
give to drink a strong Cretan wine, and boiled 
barley-meal for food; anoint and rub with oint- 
ments containing wax; bathe the legs and feet 
in hot water, and then cover them up; and so 
in like manner the arms, as far as the hands, and 
the spine, from the neck to the sacrum, are to 
be wrapped in a skin smeared with wax; this 
must extend to the parts beyond, and intervals 
are to be left for applying fomentations, by 
means of leather bottles filled with hot water, 
then, wrapping him up in a linen cloth, lay him 
down in bed. Do not open the bowels, unless 
by means of a suppository, when they have been 
long of being moved. If there be any remission 
of the disease, so far well, but otherwise, pound 
of the root of bryonia in fragrant wine, and that 
of the carrot, and give to the patient fasting 
early in the morning, before using the affusion, 
and immediately afterwards let him eat boiled 
barley-meal in a tepid state, and as much as he 
can take, and in addition let him drink, if he 
will, wine well diluted. If the disease yield to 
these means, so much the better, but, if other- 
wise, you must prognosticate accordingly. 

15. All diseases are resolved either by the 
mouth, the bowels, the bladder, or some other 
such organ. Sweat is a common form of resolu- 
tion in all these cases. 

1 6. You should put persons on a course of 
hellebore who are troubled with a defluxion 
from the head. But do not administer hellebore 
to such persons as are laboring under empyema 
connected with abscesses, haemoptysis, and in- 
temperament, or any other strong cause, for it 
will do no good; and if any thing unpleasant 
occur the hellebore will get the blame of it. But 
if the body have suddenly lost its powers, or if 
there be pain in the head, or obstruction of the 
ears and nose, or ptyalism, or heaviness of the 
limbs, or an extraordinary swelling of the body, 
you may administer the hellebore, provided 
these symptoms be not connected with drink- 
ing, nor with immoderate venery; nor with sor- 
row, vexation, nor insomnolency, for, if any of 
these causes exist, the treatment must have re- 
spect to it. 

17. From walking arise pains of the sides, of 
the back, of the loins, and of the hip-joint, and 
disorder of the respiration has often been from 



On Regimen in Acute Diseases 



the same cause, for, after excesses of wine and 
flatulent food, pains shoot to the loins and hips, 
accompanied with dysuria. Walking is the cause 
of such complaints, and also of coryza and 
hoarseness. 

1 8. Disorders connected with regimen, for the 
most part, make their attack accordingly as 
any one has changed his habitual mode of diet. 
For persons who dine contrary to custom expe- 
rience much swelling of the stomach, drowsi- 
ness, and fullness; and if they take supper over 
and above, their belly is disordered; such per- 
sons will be benefited by sleeping after taking 
the bath, and by walking slowly for a consider- 
able time after sleep; if, then, the bowels be 
moved, he may dine and drink a small quantity 
of wine not much diluted; but if the bowels 
are not opened, he should get his body rubbed 
with hot oil, and, if thirsty, drink of some weak 
and white wine, or a sweet wine, and take re- 
pose; if he does not sleep he should repose the 
longer. In other respects he should observe the 
regimen laid down for those who have taken 
a debauch. With regard to the bad effects of 
drinks, such as are of a watery nature pass more 
slowly through the body, they regurgitate, as 
it were, and float about the hypochondria, and 
do not flow readily by urine; when filled up 
with such a drink, he should not attempt any 
violent exertion, requiring either strength or 
swiftness, but should rest as much as possible 
until the drink has been digested along with 
the food; but such drinks as are stronger or 
more austere, occasion palpitation in the body 
and throbbing in the head, and m this case the 
person affected will do well to sleep, and take 
some hot draught for which he feels disposed; 
for abstinence is bad in headache and the ef- 
fects of a surfeit. Those who, contrary to usage, 
restrict themselves to one meal, feel empty and 
feeble, and pass hot urine in consequence of the 
emptiness of their vessels; they have a salt and 
bitter taste in the mouth; they tremble at any 
work they attempt; their temples throb; and 
they cannot digest their supper so well as if they 
had previously taken their dinner. Such persons 
should take less supper than they are wont, and 
a pudding of barley-meal more moist than usu- 
al instead of bread, and of potherbs the dock, or 
mallow, and ptisan, or beets, and along with the 
food they should take wine in moderation, and 
diluted with water; after supper they should 
take a short walk, until the urine descend and 
be passed; and they may use boiled fish. 

Articles of food have generally such effects 
as the following: Garlic occasions flatulence and 



heat about the chest, heaviness of the head, and 
nausea, and any other habitual pain is apt to 
be exasperated by it; it is diuretic, which, in so 
far, is a good property which it possesses; but 
it is best to eat it when one means to drink to 
excess, or when intoxicated. Cheese produces 
flatulence and constipation, and heats the other 
articles of food; and it gives rise to crudities and 
indigestion, but it is worst of all to eat it along 
with drink after a full meal. Pulse of all kinds 
are flatulent,whether raw, boiled, or fried; least 
so when macerated in water, or in a green state; 
they should not be used except along with food 
prepared from the cereal ia. Each of these arti- 
cles, however, has bad effects peculiar to itself. 
The vetch, whether raw or boiled, creates flatu- 
lence and pain. The lentil is astringent, and dis- 
orders the stomach if taken with its hull. The 
lupine has the fewest bad effects of all these 
things. The stalk and the juice of silphium 
(asafcetida), pass through some people's bowels 
very readily, but in others, not accustomed to 
them, they engender what is called dry cholera; 
this complaint is more especially produced by 
it if mixed with much cheese, or eaten along 
with beef. Melancholic diseases are most par- 
ticularly exacerbated by beef, for it is of an un- 
manageable nature, and requires no ordinary 
powers of stomach to digest it; it will agree best 
with those who use it well boiled and pretty 
long kept. Goat's flesh has all the bad properties 
of beef; it is an indigestible, more flatulent and 
engenders acid eructations and cholera; such as 
has a fragrant smell, is firm, and sweet to the 
taste, is the best, when well baked and cooled; 
but those kinds which are disagreeable to the 
taste, have a bad smell, and are hard, such are 
particularly bad, and especially if very fresh; 
it is best in summer and worst in autumn. The 
flesh of young pigs is bad, either when it is too 
raw or when it is over-roasted, for it engenders 
bile and disorders the bowels. Of all kinds of 
flesh, pork is the best; it is best when neither 
very fat, nor, on the other hand, very lean, and 
the animal had not attained the age of what is 
reckoned an old victim; it should be eaten with- 
out the skin, and in a coldish state. 

19. In dry cholera the belly is distended with 
wind, there is rumbling in the bowels, pain in 
the sides and loins, no dejections, but, on the 
contrary, the bowels are constipated. In such a 
case you should guard against vomiting, but 
endeavor to get the bowels opened. As quickly 
as possible give a clyster of hot water with plen- 
ty of oil in it, and having rubbed the patient 
freely with unguents, put him into hot water, 



42- 



Hippocrates 



laying him down in the basin, and pouring the 
hot water upon him by degrees; and if, when 
heated in the bath, the bowels be moved, he 
will be freed from the complaint. To a person 
in such a complaint it will do good if he sleep, 
and drink a thin, old, and strong wine; and 
you should give him oil, so that he may settle, 
and have his bowels moved, when he will be 
relieved. He must abstain from all other kinds 
of food; but when the pain remits, give him 
asses' milk to drink until he is purged. But if 
the bowels are loose, with bilious discharges, 
tormina, vomitings, a feelingof suffocation, and 
gnawing pains, it is best to enjoin repose, and 
to drink hydromel, and avoid vomiting. 

20. There arc two kinds of dropsy, the one 
anasarca, which, when formed, is incurable; 
the other is accompanied with emphysema 
(tympanites?) and requires much good for- 
tune to enable one to triumph over it. Labori- 
ous exertion, fomentation, and abstinence (are 
to be enjoined). The patient should eat dry and 
acrid things, for thus will he pass the more 
water, and his strength be kept up. If he labors 
under difficulty of breathing, if it is the summer 
season, and if he is in the prime of life, and is 
strong, blood should be abstracted from the 
arm, and then he should eat hot pieces of bread, 
dipped in dark wine and oil, drink very little, 
and labor much, and live on well-fed pork, 
boiled with vinegar, so that he may be able to 
endure hard exercises. 

21. Those who have the inferior intestines 
hot, and who pass acrid and irregular stools of 
a colliquative nature, if they can bear it, should 
procure revulsion by vomiting with hellebore; 
but if not, should get a thick decoction of sum- 
mer wheat in a cold state, lentil soup, bread 
cooked with cinders, and fish, which should be 
taken boiled if they have fever, but roasted if 
not feverish; and also dark-colored wine if free 
of fever; but otherwise they should take the 
water from medlars, myrtles, apples, services, 
dates, or wild vine. If there be no fever, and if 
there be tormina, the patient should drink hot 
asses' milk in small quantity at first, and grad- 
ually increase it, and linseed, and wheaten flour, 
and having removed the bitter part of Egyptian 
beans, and ground them, sprinkle on the milk 
and drink; and let him eat eggs half-roasted, 
and fine flour, and millet, and perl-spelt (chon- 
drus) boiled in milk; all these things should 
be eaten cold, and similar articles of food and 
drink should be administered. 

22. The most important point of regimen to 
observe and be guarded about in protracted dis- 



eases, is to pay attention to the exacerbations 
and remissions of fevers, so as to avoid the 
times when food should not be given, and to 
know when it may be administered without 
danger; this last season is at the greatest pos- 
sible distance from the exacerbation. 

23. One should be able to recognize those 
who have headache from gymnastic exercises, 
or running, or walking or hunting, or any other 
unseasonable labor, or from immoderate ven- 
ery; also those who are of a pale color, or trou- 
bled with hoarseness; those who have enlarged 
spleen, those who are in a state of anaemia, those 
who are suffering from tympanites, those hav- 
ing dry cough and thirst, those who are flatu- 
lent, and have the course of the blood in their 
veins intercepted; those persons whose hypo- 
chondria, sides, and back are distended; those 
having torpor; those laboring under amaurosis, 
or having noises in their ears; those suffering 
from incontinence of urine or jaundice, or whose 
food is passed undigested; those who have dis- 
charges of blood from the nose or anus, or who 
have flatulence and intense pain, and who can- 
not retain the wind. In these cases you may do 
mischief, but cannot possibly do any good by 
purging, but may interrupt the spontaneous re- 
missions and crises of the complaints. 

24. If you think it expedient to let blood, see 
that the bowels be previously settled, and then 
bleed; enjoin abstinence, and forbid the use of 
wine; and complete the cure by means of a suit- 
able regimen, and wet fomentations. But if the 
bowels appear to be constipated, administer a 
soothing clyster. 

25. If you think it necessary to give medi- 
cines, you may safely purge upwards by helle- 
bore, but none of those should be purged down- 
wards. The most effectual mode of treatment 
is by the urine, sweats, and exercise; and use 
gentle friction so as not to harden the constitu- 
tion; and if he be confined to bed let others rub 
him. When the pain is seated above the dia- 
phragm, place him erect for the most part, and 
let him be as little reclined as possible; and 
when he is raised up let him be rubbed for a 
considerable time with plenty of hot oil. But if 
the pains be in the lower belly below the dia- 
phragm, it will be useful to lie reclined and 
make no motion, and to such a person nothing 
should be administered except the friction. 
Those pains which are dissolved by discharges 
from the bowels, by urine, or moderate sweats, 
cease spontaneously, if they are slight, but if 
strong they prove troublesome; for persons so 
affected either die, or at least do not recover 



On Regimen in Acute Diseases 



43 



without further mischief, for they terminate in 
abscesses. 

26. A draught for a dropsical person. Take 
three cantharides, and removing their head, 
feet, and wings, triturate their bodies in three 
cupfuls (cyathi) of water, and when the person 
who has drunk the draught complains of pain, 
let him have hot fomentations applied. The 
patient should be first anointed with oil, should 
take the draught fasting, and eat hot bread with 
oil. 

27. A styptic. Apply the juice of the fig in- 
wardly to the vein; or having moulded biestings 
into a tent, introduce up the nostril, or push up 
some chalcitis with the finger, and press the 
cartilages of the nostrils together; and open the 
bowels with the boiled milk of asses: or having 
shaved the head apply cold things to it if in 
the summer season. 

28. The sesamoides purges upwards when 
pounded in oxymel to the amount of a drachm 
and a half, and drunk; it is combined with the 
hellebores, to the amount of the third part, and 
thus it is less apt to produce suffocation. 

29. Trichiasts. Having introduced a thread 
into the eye of a needle push it through the up- 
per part of the distended eyelid, and do the same 
at the base of it; having stretched the threads 
tie a knot on them, and bind up until they drop 
out: and, if this be sufficient, so far well; but if 
otherwise, you must do the same thing again. 
And hemorrhoids, in like manner, you may 
treat by transfixing them with a needle and ty- 
ing them with a very thick and large woolen 
thread; for thus the cure will be more certain. 
When you have secured them, use a septic ap- 
plication, and do not foment until they dropoff, 
and always leave one behind; and when the pa- 
tient recovers, let him be put upon a course of 
hellebore. Then let him be exercised and sweat- 
ed; the friction of the gymnasium and wrestling 
in the morning will be proper; but he must ab- 
stain from running, drinking, and all acrid 
substances, except marjoram; let him take an 
emetic every seven days, or three times in a 
month; for thus will he enjoy the best bodily 
health. Let him take straw-colored, austere, and 
watery wine, and use little drink. 

30. For persons affected with empyema. Hav- 
ing cut some bulbs or squill, boil in water, and 
when well boiled, throw this away, and having 
poured in more water, boil until it appear to 
the touch soft and well-boiled; then triturate 
finely and mix roasted cumin, and white ses- 
ames, and young almonds pounded in honey, 
form into an electuary and give; and afterwards 



sweet wine. In draughts, having pounded about 
a small acetabulum of the white poppy, moisten 
it with water in which summer wheat has been 
washed, add honey, and boil. Let him take this 
frequently during the day. And then taking in- 
to account what is to happen, give him sup- 
per. 

31. For dysentery. A fourth part of a pound 
of cleaned beans, and twelve shoots of madder 
having been triturated, are to be mixed togeth- 
er and boiled, and given as a linctus with some 
fatty substance. 

32. For diseases of the eyes. Washed spodium 
(tutty?) mixed with grease, and not of a thin- 
ner consistence than dough, is to be carefully 
triturated, and moistened with the juice of un- 
ripe raisins; and having dried in the sun, mois- 
ten until it is of the consistence of an ointment. 
When it becomes again dry, let it be finely levi- 
gated, anoint the eyes with it, and dust it upon 
the angles of the eyes. 

33. For watery eyes. Take one drachm of eb- 
eny and nine oboli of burnt copper, rub them 
upon a whetstone, add three oboli of saffron; 
triturate all these things reduced to a fine pow- 
der, pour in an Attic hemina of sweet wine, and 
then place in the sun and cover up; when suf- 
ficiently digested, use it. 

34. For violent pains of the eyes. Take of 
chalcitis, and of raisin, of each i dr., when di- 
gested for two days, strain; and pounding myrrh 
and saffron, and having mixed must, with these 
things, digest in the sun; and with this anoint 
the eyes when in a state of severe pain. Let it be 
kept in a copper vessel. 

35. Mode of distinguishing persons in an hys- 
terical fit. Pinch them with your fingers, and 
if they feel, it is hysterical; but if not, it is a con- 
vulsion. 

36. To persons in coma, (dropsy?) give to 
drink meconium (euphorbia peplus?) to the 
amount of a round Attic lecistyon (small aceta- 
bulum). 

37. Of squama xris, as much as three specilla 
can contain, with the gluten of summer wheat: 
levigate, pound, form into pills, and give; it 
purges water downwards. 

38. A medicine for opening the bowels. Pour 
upon figs the juice of spurge, in the proportion 
of seven to one: then put into a new vessel and 
lay past when properly mixed. Give before 
food. 

39. Pounding meconium, pouring on it wa- 
ter, and straining, and mixing flour, and bak- 
ing into a cake, with the addition of boiled 
honey, give in affections of the anus and in 



44 Hippocrates 

dropsy; and after eating of it, let the patient dromel prepared from wax: or collecting mec- 
drink of a sweet watery wine, and diluted hy- onium, lay it up for medicinal purposes. 



Of the Epidemics 



BOOK I. SECT. I. First Constitution 

i. IN THASUS, about the autumn equinox, 
and under the Pleiades, the rains were abun- 
dant, constant, and soft, with southerly winds; 
the winter southerly, the northerly winds faint, 
droughts; on the whole, the winter having the 
character of spring. The spring was southerly, 
cool, rains small in quantity. Summer, for the 
most part, cloudy, no rain, the Etesian winds, 
rare and small, blew in an irregular manner. 
The whole constitution of the season being thus 
inclined to the southerly, and with droughts ear- 
ly in the spring, from the preceding opposite and 
northerly state, ardent fevers occurred in a few 
instances, and these very mild, being rarely at- 
tended with hemorrhage, and never proving fa- 
tal. Swellings appeared about the ears, in many 
on either side, and in the greatest number on 
both sides, being unaccompanied by fever so as 
not to confine the patient to bed; in all cases 
they disappeared without giving trouble, neither 
did any of them come to suppuration, as is com- 
mon in swellings from other causes. They were 
of a lax, large, diffused character, without in- 
flammation or pain, and they went away with- 
out any critical sign. They seized children, 
adults, and mostly those who were engaged in 
the exercises of the palestra and gymnasium, 
but seldom attacked women. Many had dry 
coughs without expectoration, and accompa- 
nied with hoarseness of voice. In some instances 
earlier, and in others later, inflammations with 
pain seized sometimes one of the testicles, and 
sometimes both; some of these cases were ac- 
companied with fever and some not; the great- 
er part of these were attended with much suf- 
fering. In other respects they were free of dis- 
ease, so as not to require medical assistance. 

2. Early in the beginning of spring, and 
through the summer, and towards winter, many 
of those who had been long gradually declin- 
ing, took to bed with symptoms of phthisis; in 
many cases formerly of a doubtful character 
the disease then became confirmed; in these the 
constitution inclined to the phthisical. Many, 
and, in fact, the most of them, died; and of those 
confined to bed, I do not know if a single indi- 
vidual survived for any considerable time; they 



died more suddenly than is common in such 
cases. But other diseases, of a protracted char- 
acter, and attended with fever, were well sup- 
ported, and did not prove fatal: of these we will 
give a description afterwards. Consumption was 
the most considerable of the diseases which then 
prevailed, and the only one which proved fatal 
to many persons. Most of them were affected 
by these diseases in the following manner: fe- 
vers accompanied with rigors, of the continual 
type, acute, having no complete intermissions, 
but of the form of the semi-tertians, being mild- 
er the one day, and the next having an exacerba- 
tion, and increasing in violence; constant sweats, 
but not diffused over the whole body; extremi- 
ties very cold, and warmed with difficulty; bow- 
els disordered, with bilious, scanty, unmixed, 
thin, pungent, and frequent dejections. The 
urine was thin, colorless, unconcocted, or thick, 
with a deficient sediment, not settling favorably, 
but casting down a crude and unseasonable 
sediment. Sputa small, dense, concocted, but 
brought up rarely and with difficulty; and in 
those who encountered the most violent symp- 
toms there was no concoction at all, but they 
continued throughout spitting crude matters. 
Their fauces, in most of them, were painful 
from first to last, having redness with inflam- 
mation; defluxions thin, small and acrid; they 
were soon wasted and became worse, having 
no appetite for any kind of food throughout; 
no thirst; most persons delirious when near 
death. So much concerning the phthisical affec- 
tions. 

3. In the course of the summer and autumn 
many fevers of the continual type, but not vio- 
lent; they attacked persons who had been long 
indisposed, but who were otherwise not in an 
uncomfortable state. In most cases the bowels 
were disordered in a very moderate degree, and 
they did not suffer thereby in any manner 
worth mentioning; the urine was generally well 
colored, clear, thin, and after a time becoming 
concocted near the crisis. They had not much 
cough, nor was it troublesome; they were not de- 
ficient in appetite, for it was necessary to give 
them food (on the whole, persons laboring un- 
der phthisis were not affected in the usual man- 
ner). They were affected with fevers, rigors, 



Of the Epidemics 



45 



nd deficient sweats, with varied and irregular 
aroxysms, in general not intermitting, but hav- 
ng exacerbations in the tertian form. The car- 
iest crisis which occurred was about the twen- 
icth day, in most about the fortieth, and in 
nany about the eightieth. But there were cases 
n which it did not leave them thus at all, but 
i an irregular manner, and without any crisis; 
i most of these the fevers, after a brief interval, 
elapsed again; and from these relapses they 
ame to a crisis in the same periods; but in many 
hey were prolonged so that the disease was not 
;one at the approach of winter. Of all those 
/hich are described under this constitution, the 
phthisical diseases alone were of a fatal char- 
cter; for in all the others the patients bore up 
veil, and did not die of the other fevers. 

>ECT. II. Second Constitution 

i. In Thasus, early in autumn, the winter sud- 
lenly set in rainy before the usual time, with 
nuch northerly and southerly winds. These 
hings all continued so during the season of 
he Pleiades, and until their setting. The win- 
er was northerly, the rains frequent, in tor- 
ents, and large, with snow, but with a fre- 
[uent mixture of fair weather. These things 
vere all so, but the setting in of the cold was 
lot much out of season. After the winter sol- 
tice, and at the time when the zephyr usually 
Begins to blow, severe winterly storms out of 
eason, with much northerly wind, snow, con- 
inued and copious rains; the sky tempestuous 
nd clouded; these things were protracted, and 
lid not remit until the equinox. The spring 
V2LS cold, northerly, rainy, and clouded; the 
ummer was not very sultry, the Etesian winds 
dew constant, but quickly afterwards, about 
he rising of Arcturus, there were again many 
ains with north winds. The whole season be- 
ng wet, cold, and northerly, people were, for 
he most part, healthy during winter; but early 
i the spring very many, indeed, the greater part, 
vere valetudinary. At first ophthalmies set in, 
vith rheums, pains, unconcocted discharges, 
mall concretions, generally breaking with dif- 
iculty, in most instances they relapsed, and they 
id not cease until late in autumn. During sum- 
ner and autumn there were dysenteric affec- 
ions, attacks of tenesmus and lientery, bilious 
liarrhcea, with thin, copious, undigested, and 
crid dejections, and sometimes with watery 
tools; many had copious dcfluxions, with pain, 
>f a bilious, watery, slimy, purulent nature, at- 
ended with strangury, not connected with dis- 
ase of the kidneys, but one complaint succeed- 



ing the other; vomitings of bile, phlegm, and 
undigested food, sweats, in all cases a redun- 
dance of humors. In many instances these com- 
plaints were unattended with fever, and did not 
prevent the patients from walking about, but 
some cases were febrile, as will be described. In 
some all those described below occurred with 
pain. During autumn, and at the commence- 
ment of winter, there were phthisical com- 
plaints, continual fevers; and, in a few cases, ar- 
dent; some diurnal, others nocturnal, semi-ter- 
tians, true tertians, quartans, irregular fevers. 
2. All these fevers described attacked great 
numbers. The ardent fevers attacked the small- 
est numbers, and the patients suffered the least 
from them, for there were no hemorrhages, ex- 
cept a few and to a small amount, nor was there 
delirium; all the other complaints were slight; 
in these the crises were regular, in most in- 
stances, with the intermittents, in seventeen 
days; and I know no instance of a person dying 
of causus, nor becoming phrenitic. The tertians 
were more numerous than the ardent fevers, 
and attended with more pain; but these all had 
four periods in regular succession from the first 
attack, and they had a complete crisis in seven, 
without a relapse in any instance. The quartans 
attacked many at first, in the form of regular 
quartans, but in no few cases a transition from 
other fevers and diseases into quartans took 
place; they were protracted, as is wont with 
them, indeed, more so than usual. Quotidian, 
nocturnal, and wandering fevers attacked many 
persons, some of whom continued to keep up, 
and others were confined to bed. In most in- 
stances these fevers were prolonged under the 
Pleiades and till winter. Many persons, and 
more especially children, had convulsions from 
the commencement; and they had fever, and the 
convulsions supervened upon the fevers; in most 
cases they were protracted, but free from danger, 
unless in those who were in a deadly state from 
other complaints. Those fevers which were con- 
tinual in the main, and with no intermissions, 
but having exacerbations in the tertian form, 
there being remissions the one day and exacerba- 
tions the next, were the most violent of all those 
which occurred at that time, and the most pro- 
tracted, and occurring with the greatest pains, 
beginning mildly, always on the whole increas- 
ing, and being exacerbated, and always turning 
worse, having small remissions, and after an 
abatement having more violent paroxysms, and 
growing worse, for the most part, on the critical 
days. Rigors, in all cases, took place in an ir- 
regular and uncertain manner, very rare and 



Hippocrates 



weak in them, but greater in all other fevers; 
frequent sweats, but most seldom in them, bring- 
ing no alleviation, but, on the contrary, doing 
mischief. Much cold of the extremities in them, 
and these were warmed with difficulty. Insom- 
nolcncy, for the most part, especially in these 
fevers, and again a disposition to coma. The 
bowels, in all diseases, were disordered, and in a 
bad state, but worst of all in these. The urine, in 
most of them, was either thin and crude, yellow, 
and after a time with slight symptoms of con- 
coction in a critical form, or having the proper 
thickness, but muddy, and neither settling nor 
subsiding; or having small and bad, and crude 
sediments; these being the worst of all. Coughs 
attended these fevers, but I can not state that any 
harm or good ever resulted from the cough. 

3. The most of these were protracted and trou- 
blesome, went on in a very disorderly and ir- 
regular form, and, for the most part, did not end 
in a crisis, either in the fatal cases or in the oth- 
ers; for if it left some of them for a season it 
soon returned again. In a few instances the fever 
terminated with a crisis; in the earliest of these 
about the eightieth day, and some of these re- 
lapsed, so that most of them were not free from 
the fever during the winter; but the fever left 
most of them without a crisis, and these things 
happened alike to those who recovered and to 
those who did not. There being much want of 
crisis and much variety as to these diseases, the 
greatest and worst symptom attended the most 
of them, namely, a loathing of all articles of 
food, more especially with those who had other- 
wise fatal symptoms; but they were not un- 
seasonably thirsty in such fevers. After a length 
of time, with much suffering and great wasting, 
abscesses were formed in these cases, either un- 
usually large, so that the patients could not sup- 
port them, or unusually small, so that they did 
no good, but soon relapsed and speedily got 
worse. The diseases which attacked them were 
in the form of dysenteries, tenesmus, hentery, 
and fluxes; but, in some cases, there were drop- 
sies, with or without these complaints. What- 
ever attacked them violently speedily cut them 
off, or again, did them no good. Small rashes, 
and not corresponding to the violence of the 
disease, and quickly disappearing, or swellings 
occurred about the ears, which were not re- 
solved, and brought on no crisis- In some they 
were determined to the joints, and especially to 
the hip-joint, terminating critically with a few, 
and quickly again increasing to its original habit. 

4. People died of all these diseases, but mostly 
of these fevers, and notably infants just weaned, 



and older children, until eight or ten years of 
age, and those before puberty. These things 
occurred to those affected with the complaints 
described above, and to many persons at first 
without them. The only favorable symptom, 
and the greatest of those which occurred, and 
what saved most of those who were in the great- 
est dangers, was the conversion of it to a stran- 
gury, and when, in addition to this, abscesses 
were formed. The strangury attacked, most 
especially, persons of the ages I have mentioned, 
but it also occurred in many others, both of 
those who were not confined to bed and those 
who were. There was a speedy and great 
change in all these cases. For the bowels, if 
they happened previously to have watery dis- 
charges of a bad character, became regular, they 
got an appetite for food, and the fevers were 
mild afterwards. But, with regard to the stran- 
gury itself, the symptoms were protracted and 
painful. Their urine was copious, thick, of vari- 
ous characters, red, mixed with pus, and was 
passed with pain. These all recovered, and I did 
not see a single instance of death among them. 

5. With regard to the dangers of these cases, 
one must always attend to the seasonable con- 
coction of all the evacuations, and to the favor- 
able and critical abscesses. The concoctions in- 
dicate a speedy crisis and recovery of health; 
crude ancl undigested evacuations, and those 
which are converted into bad abscesses, indi- 
cate either want of crisis, or pains, or prolonga- 
tion of the disease, or death, or relapses; which 
of these it is to be must be determined from 
other circumstances. The physician must be able 
to tell the antecedents, kjiow the present, and 
foretell the future must meditate these things, 
and have two special objects in view with re- 
gard to diseases, namely, to do good or to do 
no harm. The art consists in three things the 
disease, the patient, and the physician. The 
physician is the servant of the art, and the pa- 
tient must combat the disease along with the 
physician. * 

6. Pains about the head and neck, and heavi- 
ness of the same along with pain, occur either 

1 Galen, in ins Commentary, remarks that the 
first time he read this passage he thought it un- 
worthy of Hippocrates to lay it down as a rule of 
practice, that "the physician should do good to his 
patient, or at least no harm"; but that, after having 
seen a good deal of the practice of other physicians, 
and observed how often they were justly exposed 
to censure for having bled, or applied the bath, or 
given medicines, or wine unseasonably, he came 
to recognize the propriety and importance ot the 



Of the Epidemics 



without fevers or in fevers. Convulsions occur- 
ing in persons attacked with frenzy, and hav- 
ng vomitings of verdigris-green bile, in some 
ases quickly prove fatal. In ardent fevers, and 
n those other fevers in which there is pain of 
he neck, heaviness of the temples, mistiness 
bout the eyes, and distention about the hypo- 
hondriac region, not unattended with pain, 
icmorrhage from the nose takes place, but 
hose who have heaviness of the whole head, 
ardialgia and nausea, vomit bilious and pi- 
uitous matters; children, in such affections, 
re generally attacked with convulsions, and 
yomen have these and also pains of the uterus; 
/hereas, in elder persons, and those in whom 
he heat is already more subdued, these cases 
nd in paralysis, mania, and loss of sight. 

Third Constitution 

7. In Thasus, a little before and during the 
eason of Arcturus, there were frequent and 
;reat rains, with northerly winds. About the 
quinox, and till the setting of the Pleiades, 
here were a few southerly rains: the winter 
lortherly and parched, cold, with great winds 
,nd snow. Great storms about the equinox, the 
pring northerly, dry ness, rains few and cold. 
(bout the summer solstice, scanty rains, and 
;reat cold until near the season of the Dog-star. 
{her the Dog-days, until the season of Arc- 
urus, the summer hot, great droughts, not in 
ntervals, but continued and severe: no rain; 
he Etesian winds blew; about the season of 
Arcturus southerly rains until the equinox. 

8. In this state of things, during winter, para- 
legia set in, and attacked many, and some died 
peedily; and otherwise the disease prevailed 
luch in an epidemical form, but persons re- 
lained free from all other diseases. Early in 
be spring, ardent fevers commenced and con- 
inued through the summer until the equinox, 
"hose then that were attacked immediately 
fter the commencement of the spring and 
ummer, for the most part recovered, and but 
cw of them died. But when the autumn and 
he rains had set in, they were of a fatal char- 
cter, and the greater part then died. When in 
hese attacks of ardent fevers there was a proper 
nd copious hemorrhage from the nose, they 

ule laid down by Hippocrates. The practice of cer- 
lin physicians, Galen remarks, is like playing at 
tie dice, when what turns up may occasion the 
reatest mischief to their patients. Galen, however, 
iforms us that in some of the MSS. instead of 
art" he found "nature"; that is to say, that the 
hysician is "the minister (or servant) of nature." 



47 

were generally saved by it, and I do not know a 
single person who had a proper hemorrhage 
who died in this constitution. Philiscus, Epami- 
non, and Silenus, indeed, who had a trifling 
epistaxis on the fourth and fifth day, died. Most 
of those taken with the disease had a rigor about 
the time of the crisis, and notably those who had 
no hemorrhage; these had also rigor associated. 

9. Some were attacked with jaundice on the 
sixth day, but these were benefited either by an 
urinary purgation, or a disorder of the bowels, 
or a copious hemorrhage, as in the case of Hera- 
elides, who was lodged with Aristocydes: this 
person, though he had the hemorrhage from the 
nose, the purgation by the bladder, and disorder 
of the bowels, experienced a favorable crisis on 
the twentieth day, not like the servant of Pha- 
nagoras, who had none of these symptoms, and 
died. The hemorrhages attacked most persons, 
but especially young persons and those in the 
prime of life, and the greater part of those who 
had not the hemorrhage died: elderly persons 
had jaundice or disorder of the bowels, such as 
Bion, who was lodged with Silenus. Dysenter- 
ies were epidemical during the summer, and 
some of those cases in which the hemorrhage 
occurred, terminated in dysentery, as hap- 
pened to the slave of Eraton, and to Mullus, 
who had a copious hemorrhage, which settled 
down into dysentery, and they recovered. This 
humor was redundant in many cases, since in 
those who had not the hemorrhage about the 
crisis, but the risings about the ears disap- 
peared, after their disappearance there was a 
sense of weight in the left flank extending to 
the extremity of the hip, and pain setting in 
after the crisis, with a discharge of thin urine; 
they began to have small hemorrhages about 
the twenty-fourth day, and the swelling was 
converted into the hemorrhage. In the case of 
Antiphon, the son of Critobulus' son, the fe- 
ver ceased and came to a crisis about the forti- 
eth day. 

10. Many women were seized, but fewer than 
of the men, and there were fewer deaths among 
them. But most of them had difficult parturi- 
tion, and after labor they were taken ill, and 
these most especially died, as, for example, the 
daughter of Tclcbolus died on the sixth day aft- 
er delivery. Most females had the menstrual dis- 
charge during the fever, and many girls had it 
then for the first time: in certain individuals 
both the hemorrhage from the nose and the men- 
ses appeared; thus, in the case of the virgin 
daughter of Daetharses, the menses then took 
place for the first time, and she had also a copi- 



Hippocrates 



ous hemorrhage from the the nose, and I knew 
no instance of any one dying when one or other 
of these took place properly. But all those in the 
pregnant state that were attacked had abortions, 
as far as I observed. The urine in most cases 
was of the proper color, but thin, and having 
scanty sediments: in most the bowels were dis- 
ordered with thin and bilious dejections; and 
many, after passing through the other crises, 
terminated in dysenteries, as happened to Xen- 
ophanes and Critias. The urine was watery, co- 
pious, clear, and thin; and even after the crises, 
when the sediment was natural, and all the oth- 
er critical symptoms were favorable, as I recol- 
lect having happened to Bion, who was lodged 
in the house of Silenus, and Critias, who lived 
with Xenophanes, the slave of Areton, and the 
wife of Mnesistratus. But afterwards all these 
were attacked with dysentery. It would be worth 
while to inquire whether the watery urine was 
the cause of this. About the season of Arcturus 
many had the crisis on the eleventh day, and in 
them the regular relapses did not take place, but 
they became comatose about this time, especial- 
ly children; but there were fewest deaths of all 
among them. 

ii. About the equinox, and until the season 
of the Pleiades, and at the approach of winter, 
many ardent fevers set in; but great numbers 
at that season were seized with phrenitis, and 
many died; a few cases also occurred during 
the summer. These then made their attack at 
the commencement of ardent fevers, which 
were attended with fatal symptoms; for im- 
mediately upon their setting in, there were 
acute fever and small rigors, insomnolency, 
aberration, thirst, nausea, insignificant sweats 
about the forehead and clavicles, but no general 
perspiration; they had much delirious talking, 
fears, despondency, great coldness of the ex- 
tremities, in the feet, but more especially in 
their hands: the paroxysms were on the even 
days; and in most cases, on the fourth day, the 
most violent pains set in, with sweats, generally 
coldish, and the extremities could not be warm- 
ed, but were livid and rather cold, and they 
had then no thirst; in them the urine was black, 
scanty, thin, and the bowels were constipated; 
there was an hemorrhage from the nose in no 
case in which these symptoms occurred, but 
merely a trifling epistaxis; and none of them 
had a relapse, but they died on the sixth day 
with sweats. In the phrenitic cases, all the symp- 
toms which have been described did not occur, 
but in them the disease mostly came to a crisis 
on the eleventh day, and in some on the twen- 



tieth. In those cases in which the phrenitis die 
not begin immediately, but about the third 01 
fourth day, the disease was moderate at th< 
commencement, but assumed a violent char 
acter about the seventh day. There was a greai 
number of diseases, and of those affected, the} 
who died were principally infants, young per 
sons, adults having smooth bodies, white skins 
straight and black hair, dark eyes, those living 
recklessly and luxuriously; persons with shrill 
or rough voices, who stammered and wen 
passionate, and women more especially dice 
from this form. In this constitution, four symp 
toms in particular proved salutary; either i 
hemorrhage from the nose, or a copious dis 
charge by the bladder of urine, having an abun 
dant and proper sediment, or a bilious disordei 
of the bowels at the proper time, or an attack 
of dysentery. And in many cases it happened 
that the crisis did not take place by any one oJ 
the symptoms which have been mentioned, but 
the patient passed through most of them, and 
appeared to be in an uncomfortable way, anc 
yet all who were attacked with these symptoms 
recovered. All the symptoms which I have de 
scribed occurred also to women and girls; anc 
whoever of them had any of these symptomj 
in a favorable manner, or the menses appearec 
abundantly, were saved thereby, and had a 
crisis, so that I do not know a single female 
who had any of these favorably that died. Bui 
the daughter of Philo, who had a copious hem 
orrhage from the nose, and took supper un 
seasonably on the seventh day, died. In those 
cases of acute, and more especially of ardenl 
fevers, in which there is an involuntary dis 
charge of tears, you may expect a nasal hemor- 
rhage unless the other symptoms be of a fatal 
type, for in those of a bad description, they dc 
not indicate a hemorrhage, but death. 

12. Swellings about the ears, with pain in 
fevers, sometimes when the fever went off criti 
cally, neither subsided nor were converted intc 
pus; in these cases a bilious diarrhoea, or dysen- 
tery, or thick urine having a sediment, carried 
off the disease, as happened to Hermippus oi 
Clazomena?. The circumstances relating tc 
crises, as far as we can recognize them, were sc 
far similar and so far dissimilar. Thus two 
brothers became ill at the same hour (they 
were brothers of Epigenes, and lodged near the 
theatre), of these the elder had a crisis on the 
sixth day, and the younger on the seventh, and 
both had a relapse at the same hour; it then left 
them for five days, and from the return of the 
fever both had a crisis together on the seven- 



Of the Epidemics 



49 



teenth day. Most had a crisis on the sixth day; 
it then left them for six days, and from the re- 
lapse there was a crisis on the fifth day. But those 
who had a crisis on the seventh day, had an in- 
termission for seven days; and the crisis took 
place on the third day after the relapse. Those 
who had a crisis on the sixth day, after an inter- 
val of six days were seized again on the third, 
and having left them for one day, the fever at- 
tacked them again on the next and came to a 
crisis, as happened to Evagon the son of Da> 
tharses. Those in whom the crisis happened on 
the sixth day, had an intermission of seven days, 
and from the relapse there was a crisis on the 
fourth, as happened to the daughter of Aglaidas. 
The greater part of those who were taken ill 
under this constitution of things, were affected 
in this manner, and I did not know a single case 
of recovery, in which there was not a relapse 
agreeably to the stated order of relapses; and all 
those recovered in which the relapses took place 
according to this form: nor did I know a single 
instance of those who then passed through the 
disease in this manner who had another relapse. 
13. In these diseases death generally happened 
on the sixth day, as with Epaminondas,Silenus, 
and Philiscus the son of Antagoras. Those who 
had parotid swellings experienced a crisis on 
the twentieth day, but in all these cases the dis- 
ease went off without coming to a suppuration, 
and was turned upon the bladder. But in Cra- 
tistonax, who lived by the temple of Hercules, 
and in the maid servant of Scymnus the fuller, 
it turned to a suppuration, and they died. Those 
who had a crisis on the seventh day, had an in- 
termission of nine days, and a relapse which 
came to a crisis on the fourth day from the re- 
turn of the fever, as was the case with Panta- 
cles,who resided close by the temple of Bacchus. 
Those who had a crisis on the seventh day, aft- 
er an interval of six days had a relapse, from 
which they had a crisis on the seventh day, as 
happened to Phanocritus, who was lodged with 
Gnathon the fuller. During the winter, about 
the winter solstices, and until the equinox, the 
ardent fevers and frenzies prevailed, and many 
died. The crisis, however, changed, and hap- 
pened to the greater number on the fifth day 
from the commencement, left them for four days 
and relapsed; and after the return, there was a 
crisis on the fifth day, making in all fourteen 
days. The crisis took place thus in the case of 
most children, also in elder persons. Some had 
a crisis on the eleventh day, a relapse on the 
fourteenth, a complete crisis on the twentieth; 
but certain persons, who had a rigor about the 



twentieth, had a crisis on the fortieth. The great- 
er part had a rigor along with the original crisis, 
and these had also a rigor about the crisis in the 
relapse. There were fewest cases of rigor in the 
spring, more in summer, still more in autumn, 
but by far the most in winter; then hemorrhages 
ceased. 

SECT. Ill 

1. With regard to diseases, the circumstances 
from which we form a judgment of them are, 
by attending to the general nature of all, and 
the peculiar nature of each individual, to the 
disease, the patient, and the applications, to 
the person who applies them, as that makes a 
difference for better or for worse, to the whole 
constitution of the season, and particularly to 
the state of the heavens, and the nature of each 
country; to the patient's habits, regimen, and 
pursuits; to his conversation, manners, taci- 
turnity, thoughts, sleep, or absence of sleep, and 
sometimes his dreams, what and when they 
occur; to his picking and scratching; to his 
tears; to the alvine discharges, urine, sputa, 
and vomitings; and to the changes of diseases 
from the one into the other; to the deposits, 
whether of a deadly or critical character; to the 
sweat, coldness, rigor, cough, sneezing, hiccup, 
respiration, eructation, flatulence, whether 
passed silently or with a noise; to hemor- 
rhages and hemorrhoids; from these, and their 
consequences, we must form our judgment. 

2. Fevers are, the continual, some of which 
hold during the day and have a remission at 
night, and others hold during the night and have 
a remission during the day; semi-tertians, ter- 
tians, quartans, quintans, septans, nonans. The 
most acute, strongest, most dangerous, and fa- 
tal diseases, occur in the continual fever. The 
least dangerous of all, and the mildest and most 
protracted, is the quartan, for it is not only such 
from itself, but it also carries off other great dis- 
eases. In what is called the semi-tertian, other a- 
cute diseases are apt to occur, and it is the most fa- 
tal of all others, and moreover phthisical persons, 
and those laboring under other protracted dis- 
eases, are apt to be attacked by it. The nocturnal 
fever is not very fatal, but protracted; the diur- 
nal is still more protracted, and in some cases 
passes into phthisis. The septan is protracted, 
but not fatal; the nonan more protracted, and 
not fatal. The true tertian comes quickly to a 
crisis, and is not fatal; but the quintan is the 
worst of all, for it proves fatal when it precedes 
an attack of phthisis, and when it supervenes 
on persons who arc already consumptive. There 



5 

arc peculiar modes, and constitutions, and par- 
oxysms, in every one of these fevers; for exam- 
ple, the continual, in some cases at the very 
commencement, grows, as it were, and attains 
its full strength, and rises to its most dangerous 
pitch, but is diminished about and at the crisis; 
in others it begins gentle and suppressed, but 
gains ground and is exacerbated every day, and 
bursts forth with all its heat about and at the cri- 
sis; while in others, again, it commences mild- 
ly, increases, and is exacerbated until it reaches 
its acme, and then remits until at and about the 
crisis. These varieties occur in every fever, and 
in every disease. From these observations one 
must regulate the regimen accordingly. There 
are many other important symptoms allied to 
these, part of which have been already noticed, 
and part will be described afterwards, from a 
consideration of which one may judge, and de- 
cided in each case, whether the disease be acute, 
and whether it will end in death or recovery; or 
whether it will be protracted, and will end in 
death or recovery; and in what cases food is to 
be given, and in what not; and when and to 
what amount, and what particular kind of food 
is to be administered. 

3. Those diseases which have their parox- 
ysms on even days have their crises on even days; 
and those which have their paroxysms on un- 
even days have their crises on uneven days. The 
first period of those which have the crisis on 
even days, is the 4th, 6th, 8th, roth, i4th, 2oth, 
3oth,40th,6oth,8oth, iooth;and the first period 
of those which have their crises on uneven days, 
is the ist, 3d, 5th, yth, 9th, nth, i7th, 2ist, 
27th, 3 1 st. It should be known, that if the crisis 
take place on any other day than on those de- 
scribed, it indicates that there will be a relapse, 
which may prove fatal. But one ought to pay 
attention, and know in these seasons what crises 
will lead to recovery and what to death, or to 
changes for the better or the worse. Irregular 
fevers, quartans, quintans, septans, and nonans 
should be studied, in order to find out in what 
periods their crises take place. 

Fourteen Cases of Disease 

CASE I.Philiscus, who lived by the Wall, took 
to bed on the first day of acute fever; he sweated; 
towards night was uneasy. On the second day 
all the symptoms were exacerbated; late in the 
evening had a proper stool from a small clyster; 
the night quiet. On the third day, early in the 
morning and until noon, he appeared to be free 
from fever; towards evening, acute fever, with 
sweating, thirst, tongue parched; passed black 



Hippocrates 

urine; night uncomfortable, no sleep; he was 
delirious on all subjects. On the fourth, all the 
symptoms exacerbated, urine black; night more 
comfortable, urine of a better color. On the fifth, 
about mid-day, had a slight trickling of pure 
blood from the nose; urine varied in character, 
having floating in it round bodies, resembling 
semen, and scattered, but which did not fall to 
the bottom; a suppository having been applied, 
some scanty flatulent matters were passed; night 
uncomfortable, little sleep, talking incoherent- 
ly; extremities altogether cold, and could not 
be warmed; urine black; slept a little towards 
day ; loss of speech, cold sweats; extremities livid ; 
about the middle of the sixth day he died. The 
respiration throughout, like that of a person 
recollecting himself, was rare, and large, and 
spleen was swelled upon in a round tumor, the 
sweats cold throughout, the paroxysms on the 
even days. 

CASE II. Silenus lived on the Broad-way, near 
the house of Evalcidas.From fatigue, drinking, 
and unseasonable exercises, he was seized with 
fever. He began with having pain in the loins; 
he had heaviness of the head, and there was 
stiffness of the neck. On the first day the alvine 
discharges were bilious, unmixed, frothy, high 
colored, and copious ; urine black, having a black 
sediment; he was thirsty, tongue dry; no sleep 
at night. On the second, acute fever, stools more 
copious, thinner, frothy; urine black, an uncom- 
fortable night, slight delirium. On the third, 
all the symptoms exacerbated; an oblong dis- 
tention, of a softish nature, from both sides of 
the hypochondrium to the navel; stools thin, 
and darkish ; urine muddy, and darkish ; no sleep 
at night; much talking, laughter, singing, he 
could not restrain himself. On the fourth, in 
the same state. On the fifth, stools bilious, un- 
mixed, smooth, greasy; urine thin, and trans- 
parent; slight absence of delirium. On the sixth, 
slight perspiration about the head; extremities 
cold and livid; much tossing about; no passage 
from the bowels, urine suppressed, acute fever. 
On the seventh, loss of speech; extremities could 
no longer be kept warm; no discharge of urine. 
On the eighth, a cold sweat all over; red rashes 
with sweat, of a round figure, small, like vari, 
persistent, not subsiding; by means of a slight 
stimulus, a copious discharge from the bowels, 
of a thin and undigested character, with pain; 
urine acrid, and passed with pain; extremi- 
ties slightly heated; sleep slight, and comatose; 
speechless; urine thin, and transparent. On the 
ninth, in the same state. On the tenth, no drink 
taken; comatose, sleep slight; alvine discharges 



Of the Epidemics 



the same; urine abundant, and thickish; when 
allowed to stand, the sediment farinaceous and 
white; extremities again cold. On the eleventh, 
he died. At the commencement, and through- 
out, the respiration was slow and large; there 
was a constant throbbing in the hypochondri- 
um; his age was about twenty. 

CASE III.Herophon was seized with an acute 
fever; alvine discharges at first were scanty, and 
attended with tenesmus; but afterwards they 
were passed of a thin, bilious character, and fre- 
quent; there was no sleep; urine black, and thin. 
On the fifth, in the morning, deafness; all the 
symptoms exacerbated; spleen swollen; disten- 
tion of the hypochondrium; alvine discharges 
scanty, and black; he became delirious. On the 
sixth, delirious; at night, sweating, coldness; the 
delirium continued. On the seventh, he became 
cold, thirsty, was disordered in mind; at night 
recovered his senses; slept. On the eighth, was 
feverish; the spleen diminished in size; quite 
collected; had pain at first about the groin, on 
the same side as the spleen; had pains in both 
legs; night comfortable; urine better colored, 
had a scanty sediment. On the ninth, sweated; 
the crisis took place; fever remitted. On the fifth 
day afterwards, fever relapsed, spleen immedi- 
ately became swollen; acute fever; deafness a- 
gain. On the third day after the relapse, the 
spleen diminished; deafness less; legs painful; 
sweated during the night; crisis took place on 
the seventeenth day; had no disorder of the sen- 
ses during the relapse. 

CASE IV. In Thasus, the wife of Philinus, 
having been delivered of a daughter, the lochial 
discharge being natural, and other matters go- 
ing on mildly, on the fourteenth day after de- 
livery was seized with fever, attended with rig- 
or; was pained at first in the cardiac region of 
the stomach and right hypochondrium; pain in 
the genital organs; lochial discharge ceased. Up- 
on the application of a pessary all these symp- 
toms were alleviated; pains of the head, neck, 
and loins remained; no sleep; extremities cold; 
thirst; bowels in a hot state; stools scanty; urine 
thin, and colorless at first. On the sixth, towards 
night, senses much disordered, but again were 
restored. On the seventh, thirsty; the evacua- 
tions bilious, and high colored. On the eighth, 
had a rigor; acute fever; much spasm, with pain; 
talked much, incoherently; upon the applica- 
tion of a suppository, rose to stool, and passed 
copious dejections, with a bilious flux; no sleep. 
On the ninth, spasms. On the tenth, slightly re- 
collected. On the eleventh, slept; had perfect 
recollection, but again immediately wandered; 



5 1 

passed a large quantity of urine with spasms, 
(the attendants seldom putting her in mind), 
it was thick, white, like urine which has been 
shaken after it has stood for a considerable time 
until it has subsided, but it had no sediment; in 
color and consistence, the urine resembled that 
of cattle, as far as I observed. About the four- 
teenth day, startings over the whole body; talked 
much; slightly collected, but presently became 
again delirious. About the seventeenth day be- 
came speechless, on the twentieth died. 

CASE V. The wife of Epicrates, who was 
lodged at the house of Archigetes, being near 
the term of delivery, was seized with a violent 
rigor, and, as was said, she did not become 
heated; next day the same. On the third, she 
was delivered of a daughter, and everything 
went on properly. On the day following her 
delivery, she was seized with acute fever, pain 
in the cardiac region of the stomach, and in the 
genital parts. Having had a suppository, was in 
so far relieved; pain in the head, neck, and 
loins; no sleep; alvine discharges scanty, bilious, 
thin, and unmixed; urine thin, and blackish. 
Towards the night of the sixth day from the 
time she was seized with the fever, became de- 
lirious. On the seventh, all the symptoms ex- 
acerbated ; insomnolency, delirium, thirst ; stools 
bilious, and high colored. On the eighth, had a 
rigor; slept more. On the ninth, the same. On 
the tenth, her limbs painfully affected; pain 
again of the cardiac region of the stomach ; heavi- 
ness of the head ; no delirium ; slept more Bowels 
constipated. On the eleventh, passed urine of a 
better color, and having an abundant sediment; 
felt lighter. On the fourteenth had a rigor; acute 
fever. On the fifteenth, had a copious vomiting 
of bilious and yellow matters; sweated; fever 
gone; at night acute fever; urine thick, sedi- 
ment white. On the seventeenth, an exacerba- 
tion; night uncomfortable; no sleep; delirium. 
On the eighteenth, thirsty; tongue parched; no 
sleep; much delirium; legs painfully affected. 
About the twentieth, in the morning, had a slight 
rigor; was comatose; slept tranquilly; had slight 
vomiting of bilious and black matters; towards 
night deafness. About the twenty-first, weight 
generally in the left side, with pain ; slight cough ; 
urine thick, muddy, and reddish; when allowed 
to stand, had no sediment; in other respects felt 
lighter; fever not gone; fauces painful from the 
commencement, and red; uvula retracted; de- 
fluxion remained acrid, pungent, and saltish 
throughout. About the twenty-seventh, free of 
fever; sediment in the urine; pain in the side. 
About the thirty-first, was attacked with fever, 



bilious diarrhea; slight bilious vomiting on the 
fortieth. Had a complete crisis, and was freed 
from the fever on the eightieth day. 

CASEVI.Cleonactides,whowas lodged above 
the Temple of Hercules, was seized with a fever 
in an irregular form; was pained in the head 
and left side from the commencement, and had 
other pains resembling those produced by fa- 
tigue; paroxysms of the fevers inconstant and 
irregular; occasional sweats; the paroxysms gen- 
erally attacked on the critical days. About the 
twenty-fourth was cold in the extremities of the 
hands, vomitings bilious, yellow, and frequent, 
soon turning to a verdigris-green color; general 
relief. About the thirtieth, began to have hem- 
orrhage from both nostrils, and this continued 
in an irregular manner until near the crisis; did 
not loathe food, and had no thirst throughout, 
nor was troubled with insomnolency; urine thin, 
and not devoid of color. When about the thirti- 
eth day, passed reddish urine, having a copious 
red sediment; was relieved, but afterwards the 
characters of the urine varied, sometimes hav- 
ing sediment, and sometimes not. On the sixti- 
eth, the sediment in the urine copious, white, 
and smooth; all the symptoms ameliorated; in- 
termission of the fever; urine thin, and well 
colored. On the seventieth, fever gone for ten 
days. On the eightieth had a rigor, was seized 
with acute fever, sweated much; a red, smooth 
sediment in the urine; and a perfect crisis. 

CASE VII. Meton was seized with fever; there 
was a gainful weight in the loins. Next day, aft- 
er drinking water pretty copiously, had proper 
evacuations from the bowels. On the third, 
heaviness of the head, stools thin, bilious, and 
reddish. On the fourth, all the symptoms exac- 
erbated; had twice a scanty trickling of blood 
from the right nostril; passed an uncomfortable 
night; alvinc discharges like those on the third 
day; urine darkish, had a darkish cloud float- 
ing in it, of a scattered form, which did not 
subside. On the fifth, a copious hemorrhage of 
pure blood from the left nostril; he sweated, and 
had a crisis. After the fever restless, and had 
some delirium; urine thin, and darkish; had an 
affusion of warm water on the head; slept and 
recovered his senses. In this case there was no 
relapse, but there were frequent hemorrhages 
after the crisis. 

CASE VIII. Erasinus, who lived near the Canal 
of Bootes, was seized with fever after supper; 
passed the night in an agitated state. During 
the first day quiet, but in pain at night. On the 
second, symptoms all exacerbated; at night de- 
lirious. On the third, was in a painful condi- 



Hippocrates 

tion; great incoherence. On the fourth, in a most 
uncomfortable state; had no sound sleep at night, 
but dreaming and talking; then all the appear- 
ances worse, of a formidable and alarming char- 
acter; fear, impatience. On the morning of the 
fifth, was composed, and quite coherent, but 
long before noon was furiously mad, so that he 
could not constrain himself; extremities cold, 
and somewhat livid; urine without sediment; 
died about sunset. The fever in this case was 
accompanied by sweats throughout; the hypo- 
chondria were in a state of meteorism, withdis- 
tention and pain ; the urine was black, had round 
substances floating in it, which did not subside; 
the alvine evacuations were not stopped; thirst 
throughout not great; much spasms with sweats 
about the time of death. 

CASE IX. Criton, in Thasus, while still on 
foot, and going about, was seized with a violent 
pain in the great toe; he took to bed the same 
day, had rigors and nausea, recovered his heat 
slightly, at night was delirious. On the second, 
swelling of the whole foot, and about the ankle 
erythema, with distention, and small bullae 
(phlyctamae); acute fever; he became furiously 
deranged; alvine discharges bilious, unmixed, 
and rather frequent. He died on the second day 
from the commencement. 

CASE X. The Clazomenian who was lodged 
by the Well of Phrymchides was seized with 
fever. He had pain in the head, neck, and loins 
from the beginning, and immediately after- 
wards deaf ness; no sleep, acute fever, hypochon- 
dria elevated with a swelling, but not much dis- 
tention; tongue dry. On the fourth, towards 
night, he became delirious. On the fifth, in an 
uneasy state. On the sixth, all the symptoms ex- 
acerbated. About the eleventh a slight remis- 
sion ; from the commencement to the fourteenth 
day the alvine discharges thin, copious, and of 
the color of water, but were well supported; the 
bowels then became constipated. Urine through- 
out thin, and well colored, and had many sub- 
stances scattered through it, but no sediment. 
About the sixteenth, urine somewhat thicker, 
which had a slight sediment; somewhat better, 
and more collected. On the seventeenth, urine 
again thin; swellings about both his ears, with 
pain; no sleep, some incoherence; legs painful- 
ly affected. On the twentieth, free of fever, had 
a crisis, no sweat, perfectly collected. About the 
twenty-seventh, violent pain of the right hip; it 
speedily went off. The swellings about the ears 
subsided, and did not suppurate, but were pain- 
ful. About the thirty-first, a diarrhoea, attended 
with a copious discharge of watery matter, and 



Of the Epidemics 



symptoms of dysentery; passed thick urine; 
swellings about the ears gone. About the forti- 
eth day, had pain in the right eye, sight dull. It 
went away. 

CASEXI.The wife of Dromeades havingbeen 
delivered of a female child, and all other matters 
going on properly, on the second day after was 
seized with rigor and acute fever. Began to have 
pain about the hypochondrium on the first day; 
had nausea and incoherence, and for some hours 
afterwards had no sleep; respiration rare, large, 
and suddenly interrupted. On the day follow- 
ing that on which she had the rigor, alvine dis- 
charges proper; urine thick, white, muddy, like 
urine which has been shaken after standing for 
some time, until the sediment had fallen to the 
bottom; it had no sediment; she did not sleep 
during the night. On the third day, about noon, 
had a rigor, acute fever; urine the same; pain 
of the hypochondria, nausea, an uncomfortable 
night, no sleep; a coldish sweat all over, but 
heat quickly restored. On the fourth, slight al- 
leviation of the symptoms about the hypochon- 
dria; heaviness of the head, with pain; some- 
what comatose; slight epistaxis, tongue dry, 
thirst, urine thin and oily; slept a little, upon 
awaking was somewhat comatose; slight cold- 
ness, slept during the night, was delirious. On 
the morning of the sixth had a rigor, but soon 
recovered her heat, sweated all over; extremities 
cold, was delirious, respiration rare and large. 
Shortly afterwards spasms from the head be- 
gan, and she immediately expired. 

CASE XII. A man, in a heated state, took sup- 
per, and drank more than enough; he vomited 
the whole during the night; acute fever, pain of 
the right hypochondrium, a softish inflamma- 
tion from the inner part; passed an uncomfort- 
able night; urine at the commencement thick, 
red, but when allowed to stand, had no sedi- 
ment, tongue dry, and not very thirsty. On the 
fourth, acute fever, pains all over. On the fifth, 
urine smooth, oily, and copious; acute fever. On 
the sixth, in the evening, very incoherent, no 
sleep during the night. On the seventh, all the 
symptoms exacerbated; urine of the same char- 
acters; much talking, and he could not contain 
himself; the bowels being stimulated, passed a 
watery discharge with lumbrici: night equally 
painful. In the morning had a rigor; acute fe- 
ver, hot sweat, appeared to be free of fever; did 
not sleep long; after the sleep a chill, ptyalism; 
in the evening, great incoherence; after a little, 
vomited a small quantity of dark bilious mat- 
ters. On the ninth, coldness, much delirium, did 
not sleep. On the tenth, pains in the limbs, all 



53 

the symptoms exacerbated; he was delirious. On 
the eleventh, he died. 

CASE XIII. A woman, who lodged on the 
Quay, being three months gone with child, was 
seized with fever, and immediately began to 
have pains in the loins. On the third day, pain 
of the head and neck, extending to the clavicle, 
and right hand; she immediately lost the pow- 
er of speech; was paralyzed in the right hand, 
with spasms, after the manner of paraplegia; 
was quite incoherent; passed an uncomfortable 
night; did not sleep; disorder of the bowels, at- 
tended with bilious, unmixed, and scanty stools. 
On the fourth, recovered the use of her tongue; 
spasms of the same parts, and general pains re- 
mained; swelling in the hypochondrium, ac- 
companied with pain; did not sleep, was quite 
incoherent; bowels disordered, urine thin, and 
not of a good color. On the fifth, acute fever; 
pain of the hypochondrium, quite incoherent; 
alvine evacuations bilious; towards night had a 
sweat, and was freed from the fever. On the 
sixth, recovered her reason; was every way re- 
lieved; the pain remained about the left clavi- 
cle; was thirsty, urine thin, had no sleep. On 
the seventh trembling, slight coma, some inco- 
herence, pains about the clavicle and left arm 
remained; in all other respects was alleviated; 
quite coherent. For three days remained free 
from fever. On the eleventh, had a relapse, with 
rigor and fever. About the fourteenth day, vom- 
ited pretty abundantly bilious and yellow mat- 
ters, had a sweat, the fever went off, by coming 
to a crisis. 

CASE XIV. Melidia, who lodged near the Tem- 
ple of Juno, began to feel a violent pain of the 
head, neck, and chest. She was straightway 
seized with acute fever; a slight appearance of 
the menses; continued pains of all these parts. 
On the sixth, was affected with coma, nausea, 
and rigor; redness about the cheeks; slight de- 
lirium. On the seventh, had a sweat; the fever 
intermitted, the pains remained. A relapse; little 
sleep; urine throughout of a good color, but 
thin; the alvine evacuations were thin, bilious, 
acrid, very scanty, black, and fetid; a white, 
smooth sediment in the urine; had a sweat, and 
experienced a perfect crisis on the eleventh day. 

BOOK III. SECT. I 

CASE I. Pythion, who lived by the Temple of 
the Earth, on the first day, trembling commenc- 
ing from his hands; acute fever, delirium. On 
the second, all the symptoms were exacerbated. 
On the third, the same. On the fourth alvine 
discharges scanty, unmixed, and bilious. On the 



54 



Hippocrates 



fifth, all the symptoms were exacerbated, the 
tremors remained; little sleep, the bowels con- 
stipated. On the sixth sputa mixed, reddish. On 
the seventh, mouth drawn aside. On the eighth, 
all the symptoms were exacerbated; the trem- 
blings were again constant; urine, from the be- 
ginning to the eighth day, thin, and devoid of 
color; substances floating in it, cloudy. On the 
tenth he sweated; sputa somewhat digested, had 
a crisis; urine thinnish about the crisis; but aft- 
er the crisis, on the fortieth day, an abscess 
about the anus, which passed off by a strangury. 

Explanation of the characters. It is probably 
that the great discharge of urine brought about 
the resolution of the disease, and the cure of 
the patient on the fortieth day. 

CASE II. Hermocrates, who lived by the New 
Wall, was seized with fever. He began to have 
pain in the head and loins; an empty distention 
of the hypochondrium; the tongue at first was 
parched; deafness at the commencement; there 
was no sleep; not very thirsty; urine thick and 
red, when allowed to stand it did not subside; 
alvine discharge very dry, and not scanty. On 
the fifth, urine thin, had substances floating in 
it which did not fall to the bottom; at night he 
was delirious. On the sixth, had jaundice; all 
the symptoms were exacerbated; had no recol- 
lection. On the seventh, in an uncomfortable 
state; urine thin, as formerly; on the following 
days the same. About the eleventh day, all the 
symptoms appeared to be lightened. Coma set 
in; urine thicker, reddish, thin substances be- 
low, had no sediment; by degrees he became 
collected. On the fourteenth, fever gone; had 
no sweat; slept, quite collected; urine of the 
same characters. About the seventeenth, had a 
relapse, became hot. On the following days, 
acute fever, urine thin, was delirious. Again, on 
the twentieth, had a crisis; free of fever; had no 
sweat; no appetite through the whole time; was 
perfectly collected; could not speak, tongue dry, 
without thirst; deep sleep. About the twenty- 
fourth day he became heated; bowels loose, with 
a thin, watery discharge; on the following days 
acute fever, tongue parched. On the twenty- 
seventh he died. In this patient deafness con- 
tinued throughout; the urine either thick and 
red, without sediment, or thin, devoid of color, 
and, having substances floating in it: he could 
taste nothing. 

Explanation of the characters. It is probably 
that it was the suppression of the discharges 
from the bowels which occasioned death on the 
twenty-seventh day. 

CASE III. The man who was lodged i^ the 



Garden of Dealces: had heaviness of the head 
and pain in the right temple for a considerable 
time, from some accidental cause, was seized 
with fever, and took to bed. On the second, 
there was a trickling of pure blood from the 
left nostril, but the alvine discharges were prop- 
er, urine thin, mixed, having small substances 
floating in it, like coarse barley meal, or semen. 
On the third, acute fever; stools black, thin, 
frothy, a livid sediment in the dejections; slight 
coma; uneasiness at the times he had to get up; 
sediment in the urine livid, and somewhat vis- 
cid. On the fourth, slight vomiting of bilious, 
yellow matters, and, after a short interval, of 
the color of verdigris; a few drops of pure blood 
ran from the left nostril; stools the same; urine 
the same; sweated about the head and clavicles; 
spleen enlarged, pain of the thigh on the same 
side ; loose swelling of the right hypochondrium ; 
at night had no sleep, slight delirium. On the 
sixth, stools black, fatty, viscid, fetid; slept, more 
collected. On the seventh, tongue dry, thirsty, 
did not sleep; was somewhat delirious; urine 
thin, not of a good color. On the eighth, stools 
black, scanty, and compact; slept, became col- 
lected; not very thirsty. On the ninth had a rig- 
or, acute fever, sweated, a chill, was delirious, 
strabismus of the right eye, tongue dry, thirsty, 
without sleep. On the tenth, much the same. 
On the eleventh, became quite collected; free 
from fever, slept, urine thin about the crisis. 
The two following days without fever; it re- 
turned on the fourteenth, then immediately in- 
somnolency and complete delirium. On the fif- 
teenth, urine muddy, like that which has been 
shaken after the sediment has fallen to the bot- 
tom; acute fever, quite delirious, did not sleep; 
knees and legs painful; after a suppository, had 
alvine dejections of a black color. On the six- 
teenth, urine thin, had a cloudy eneorema, was 
delirious. On the seventeenth, in the morning, 
extremities cold, was covered up with the bed- 
clothes, acute fever, general sweat, felt relieved, 
more collected; not free of fever, thirsty, vomit- 
ed yellow bile, in small quantities; formed faeces 
passed from the bowels, but soon afterwards 
black, scanty, and thin; urine thin, not well col- 
ored. On the eighteenth, not collected, coma- 
tose. On the nineteenth, in the same state. On 
the twentieth, slept; quite collected, sweated, 
free from fever, not thirsty, but the urine thin. 
On the twenty-first, slight delirium; somewhat 
thirsty, pain of the hypochondrium, and throb- 
bing about the navel throughout. On the twenty- 
fourth, sediment in the urine, quite collected. 
Twenty-seventh, pain of the right hip joint; 



Of the Epidemics 



urine thin and bad, a sediment; all the other 
symptoms milder. About the twenty-ninth, pain 
of the right eye; urine thin. Fortieth, dejections 
pituitous, white, rather frequent; sweated abun- 
dantly all over; had a complete crisis. 

Explanation of the characters. It is probable 
that, by means of the stools, the urine, and the 
sweat, this patient was cured in forty days. 

SECT. II 

CASE I. In Thasus, Philistes had headache 
of long continuance, and sometimes was con- 
fined to bed, with a tendency to deep sleep; 
having been seized with continual fevers from 
drinking, the pain was exacerbated; during the 
night he, at first, became hot. On the first day, 
he vomited some bilious matters, at first yel- 
low, but afterwards of a verdigris-green color, 
and in greater quantity; formed faeces passed 
from the bowels; passed the night uncomfort- 
ably. On the second, deafness, acute fever; re- 
traction of the right hypochondrium; urine 
thin, transparent, had some small substances 
like semen floating in it; delirium ferox about 
mid-day. On the third, in an uncomfortable 
state. On the fourth, convulsions; all the symp- 
toms exacerbated. On the fifth, early in the 
morning, died. 

Explanation of the characters. It is probable 
that the death of the patient on the fifth day is 
to be attributed to a phrenitis, with unfavorable 
evacuations. 

CASE II. Charion, who was lodged at the house 
of Demacnetus, contracted a fever from drink- 
ing. Immediately he had a painful heaviness of 
the head; did not sleep; bowels disordered, with 
thin and somewhat bilious discharges. On the 
third day, acute fever; trembling of the head, 
but especially of the lower lip; after a little time 
a rigor, convulsions; he was quite delirious; 
passed the night uncomfortably. On the fourth, 
quiet, slept little, talked incoherently. On the 
fifth, in pain; all the symptoms exacerbated; de- 
lirium; passed thenight uncomfortably; did not 
sleep. On the sixth, in the same state. On the 
seventh had a rigor, acute fever, sweated all over 
his body; had a crisis. Throughout the alvine 
discharges were bilious, scanty, and unmixed; 
urine thin, well colored, having cloudy sub- 
stances floating in it. About the eighth day, pass- 
ed urine of a better color, having a white scanty 
sediment; was collected, free from fever for a 
season. On the ninth it relapsed. About the four- 
teenth, acute fever. On the sixteenth, vomited 
pretty frequently yellow, bilious matters. On 
the seventeenth had a rigor, acute fever, sweat- 



55 

ed, free of fever; had a crisis; urine, after the re- 
lapse and the crisis, well colored, having a sedi- 
ment; neither was he delirious in the relapse. 
On the eighteenth, became a little heated; some 
thirst, urine thin, with cloudy substances float- 
ing in it; slight wandering in his mind. About 
the nineteenth, free of fever, had a pain in his 
neck; a sediment in the urine. Had a complete 
crisis on the twentieth. 

Explanation of the characters. It is probable 
that the patient was cured in twenty days, by 
the abundance of bilious stools and urine. 

CASE III. The daughter of Euryanax, a maid, 
was taken ill of fever. She was free of thirst 
throughout, but had no relish for food. Alvine 
discharges small, urine thin, scanty, not well 
colored. In the beginning of the fever, had a 
pain about the nates. On the sixth day, was free 
of fever, did not sweat, had a crisis; the com- 
plaint about the nates came to a small suppura- 
tion, and burst at the crisis. After the crisis, on 
the seventh day, had a rigor, became slightly 
heated, sweated. On the eighth day after the rig- 
or, had an inconsiderable rigor; the extremities 
cold ever after. About the tenth day, after a 
sweat which came on, she became delirious, and 
again immediately afterwards was collected; 
these symptoms were said to have been brought 
on by eating grapes. After an intermission of 
the twelfth day, she again talked much incoher- 
ently ; her bowels disordered with bil ious, scanty, 
unmixed, thin, acrid discharges; she required 
to get frequently up. She died on the seventh 
day after the return of the delirium. At the com- 
mencement of the disease she had pain in the 
throat, and it was red throughout, uvula retract- 
ed, defluxions abundant, thin, acrid; coughed, 
but had no concocted sputa; during the whole 
time loathed all kinds of food, nor had the least 
desire of anything; had no thirst, nor drank 
anything worth mentioning; was silent, and 
never spoke a word; despondency; had no hopes 
of herself. She had a congenital tendency to 
phthisis. 

CASE IV. The woman affected with quinsy, 
who lodged in the house of Aristion: her com- 
plaint began in the tongue; speech inarticulate; 
tongue red and parched. On the first day, felt 
chilly, and afterwards became heated. On the 
third day, a rigor, acute fever; a reddish and 
hard swelling on both sides of the neck and 
chest, extremities cold and livid; respiration ele- 
vated; the drink returned by the nose; she could 
not swallow; alvine and urinary discharges sup- 
pressed. On the fourth, all of the symptoms were 
exacerbated. On the fifth she died of thcquinsy. 



Hippocrates 



Explanation of the characters. It is probable 
that the cause of death on the sixth day was the 
suppression of the discharges. 

CASE V. The young man who was lodged by 
the Liars' Market was seized with fever from 
fatigue, labor, and running out of season. On 
the first day, the bowels disordered, with bil- 
ious, thin, and copious dejections; urine thin 
and blackish; had no sleep; was thirsty. On the 
second all the symptoms were exacerbated; de- 
jections more copious and unseasonable; he had 
no sleep; disorder of the intellect; slight sweat. 
On the third day, restless, thirst, nausea, much 
tossing about, bewilderment, delirium; extrem- 
ities livid and cold; softish distention of the hy- 
pochondrium on both sides. On the fourth, did 
not sleep; still worse. On the seventh he died. 
He was about twenty years of age. 

Explanation of the characters. It is probable 
that the cause of his death on the seventh 
day was the unseasonable practices mentioned 
above. An acute affection. 

CASE VI. The woman who lodged at the 
house of Tisamenas had a troublesome attack 
of iliac passion, much vomiting; could not keep 
her drink; pains about the hypochondria, and 
pains also in the lower part of the belly; con- 
stant tormina; not thirsty; became hot; extrem- 
ities cold throughout, with nausea and insom- 
nolency; urine scanty and thin; dejections un- 
digested, thin, scanty. Nothing could do her 
any good. She died. 

CASE VII. A woman of those who lodged with 
Pantimides,from a miscarriage, was taken ill of 
fever. On the first day, tongue dry, thirst, nau- 
sea, insomnolency, belly disordered, with thin, 
copious, undigested dejections. On the second 
day, had a rigor, acute fever; alvine discharges 
copious; had no sleep. On the third, pains great- 
er. On the fourth, delirious. On the seventh she 
died. Belly throughout loose, with copious, thin, 
undigested evacuations; urine scanty, thin. An 
ardent fever. 

CASE VIII. Another woman, after a miscar- 
riage about the fifth month, the wife of Ocetes, 
was seized with fever. At first had sometimes 
coma and sometimes insomnolency; pain of the 
loins; heaviness of the head. On the second, the 
bowels were disordered, with scanty, thin, and 
at first unmixed dejections. On the third, more 
copious, and worse; at night did not sleep. On 
the fourth was delirious; frights, despondency; 
strabismus of the right eye; a faint cold sweat 
about the head; extremities cold. On the fifth 
day, all the symptoms were exacerbated; talked 
much incoherently, and again immediately be- 



came collected; had no thirst; labored under in- 
somnolency; alvine dejections copious, and un- 
seasonable throughout; urine scanty, thin, dark- 
ish; extremities cold, somewhat livid. On the 
sixth day, in the same state. On the seventh she 
died. Phrenitis. 

CASE IX. A woman who lodged near the 
Liars' Market, having then brought forth a son 
in a first and difficult labor, was seized with fe- 
ver. Immediately on the commencement had 
thirst, nausea, and cardialgia; tongue dry; bow- 
els disordered, with thin and scanty dejections; 
had no sleep. On the second, had slight rigor, 
acute fever; a faint cold sweat about the head. 
On the third, painfully affected; evacuations 
from the bowels undigested, thin, and copious. 
On the fourth, had a rigor; all the symptoms 
exacerbated; insomnolency. On the fifth, in a 
painful state. On the sixth, in the same state; 
discharges from the bowels liquid and copious. 
On the seventh, had a rigor, fever acute; much 
thirst; much tossing about; towards evening a 
cold sweat over all; extremities cold, could no 
longer be kept warm; and again at night had a 
rigor; extremitiescould not be warmed; she did 
not sleep; was slightly delirious, and again speed- 
ily collected. On the eighth, about mid-day, she 
became warm, was thirsty, comatose, had nau- 
sea; vomited small quantities of yellowish bile; 
restless at night, did not sleep; passed frequent- 
ly large quantities of urine without conscious- 
ness. On the ninth, all the symptoms gave way; 
comatose, towards evening slight rigors; small 
vomitingsof bile. On the tenth, rigor; exacerba- 
tion of the fever, did not sleep at all; in the morn- 
ing passed much urine having a sediment; ex- 
tremities recovered their heat. On the eleventh, 
vomited bileof a verdigris-green color; not long 
after had a rigor, and again the extremities cold; 
towards evening a rigor, a cold sweat, much 
vomiting; passed a painful night. On the 
twelfth, had copious black and fetid vomitings; 
much hiccup, painful thirst. On the thirteenth, 
vomitings black, fetid, and copious; rigor about 
mid-day, loss of speech. On the fourteenth, some 
blood ran from her nose, she died. In this case 
the bowels were loose throughout; with rigors: 
her age about seventeen. An ardent fever. 

SECT. Ill 

i. The year was southerly, rainy; no winds 
throughout. Droughts having prevailed during 
the previous seasons of the year, the south winds 
towards the rising of Arcturus were attended 
with much rain. Autumn gloomy and cloudy, 
with copious rains. Winter southerly, damp, 



Of the Epidemics 



and soft. But long after the solstice, and near the 
equinox, much wintery weather out of season; 
and when now close to the equinox, north- 
erly, and winterly weather for no long time. 
The spring again southerly, calm, much rain 
until the dog-days. Summer fine and hot; great 
suffocating heats. The Etesian winds blew small 
and irregular; again, about the season of Arctur- 
us, much rains with north winds. 

2. The year being southerly, damp, and soft 
towards winter, all were healthy, except those 
affected with phthisis, of whom we shall write 
afterwards. 

3. Early in spring, along with the prevailing 
cold, there were many cases of erysipelas, some 
from a manifest cause, and some not. They were 
of a malignant nature, and proved fatal to many; 
many had sore-throat and loss of speech. There 
were many cases of ardent fever, phrensy, aph- 
thous affections of the mouth, tumors on the 
genital organs; of ophthalmia, anthrax, disor- 
der of the bowels, anorexia, with thirst and with- 
out it; of disordered urine, large in quantity, 
and bad in quality ; of persons affected with coma 
for a long time, and then falling into a state of 
msomnolency. There were many cases of fail- 
ure of crisis, and many of unfavorable crisis; 
many of dropsy and of phthisis. Such were the 
diseases then epidemic. There were patients af- 
fected with every one of the species which have 
been mentioned, and many died. The symp- 
toms in each of these cases were as follows: 

4. In many cases erysipelas, from some obvi- 
ous cause, such as an accident, and sometimes 
from even a very small wound, broke out all 
over the body, especially, in persons about six- 
ty years of age, about the head, if such an acci- 
dent was neglected in the slightest degree; and 
this happened in some who were under treat- 
ment; great inflammation took place, and the 
erysipelas quickly spread all over. In the most 
of them the abscesses ended in suppurations, and 
there were great fallings off (sloughing) of the 
flesh, tendons, and bones; and the defluxion 
which seated in the part was not like pus, but a 
sort of putrefaction, and the running was large 
and of various characters. Those cases in which 
any of these things happened about the head 
were accompanied with falling off of the hairs of 
the head and chin, the bones were laid bare and 
separated, and there were excessive runnings; 
and these symptoms happened in fevers and 
without fevers. But these things were more for- 
midable in appearance than dangerous; for 
when the concoction in these cases turned to a 
suppuration, most of them recovered; but when 



57 

the inflammation and erysipelas disappeared, 
and when no abscess was formed, a great num- 
ber of these died. In like manner, the same things 
happened to whatever part of the body the dis- 
ease wandered, for in many cases both forearm 
and arm dropped off; and in those cases in 
which it fell upon the sides, the parts there, 
either before or behind, got into a bad state; and 
in some cases the whole femur and bones of the 
leg and whole foot were laid bare. But of all 
such cases, the most formidable were those 
which took place about the pubes and genital 
organs. 1 Such was the nature of these cases when 
attended with sores, and proceeding from an 
external cause; but the same things occurred in 
fevers, before fevers, and after fevers. But those 
cases in which an abscess was formed, and 
turned to a suppuration, or a seasonable diar- 
rhea or discharge of good urine took place, 
were relieved thereby: but those cases in which 
none of these symptoms occurred, but they dis- 
appeared without a crisis, proved fatal. The 
greater number of these erysipelatous cases 
took place in the spring, but were prolonged 
through the summer and during autumn. 

5. In certain cases there was much disorder, 
and tumors about the fauces, and inflammations 
of the tongue, and abscesses about the teeth. 
And many were attacked with impairment or 
loss of speech; at first, those in the commence- 
ment of phthisis, but also persons in ardent fe- 
ver and in phrenitis. 

6. The cases of ardent fever and phrenitis oc- 
curred early in spring after the cold set in, and 
great numbers were taken ill at that time, and 
these cases were attended with acute and fatal 
symptoms. The constitution of the ardent fevers 
which then occurred was as follows: at the com- 
mencement they were affected with coma, nau- 
sea, and rigors; fever not acute, not much thirst, 
nor delirium, slight epistaxis, the paroxysms 
for the most part on even days; and, about the 
time of the paroxysms, forgetfulness, loss of 
strength and of speech, the extremities, that is 
to say, the hands and feet, at all times, but more 
especially about the time of the paroxysms, were 
colder than natural; they slowly and imperfect- 
ly became warmed, and again recovered their 
recollection and speech. They were constantly 
affected either with coma, in which they got 
no sleep, or with insomnolency, attended with 
pains; most had disorders of the bowels, 
attended with undigested, thin, and copious 
evacuations; urine copious, thin, having noth- 

1 Compare Thucydides* description of the plague 
of Athens. 



Hippocrates 



ing critical nor favorable about it; neither 
was there any other critical appearance in per- 
sons affected thus; for neither was there any 
proper hemorrhage, nor any other of the ac- 
customed evacuations, to prove a crisis. They 
died, as it happened, in an irregular manner, 
mostly about the crisis, but in some instances 
after having lost their speech for a long time, 
and having had copious sweats. These were 
the symptoms which marked the fatal cases of 
ardent fever; similar symptoms occurred in the 
phrenitic cases; but these were particularly 
free from thirst, and none of these had wild 
delirium as in other cases, but they died op- 
pressed by a bad tendency to sleep, and stupor. 

7. But there were also other fevers, as will be 
described. Many had their mouths affected with 
aphthous ulcerations. There were also many de- 
fluxions about the genital parts, and ulcerations, 
boils (phymata), externally and internally, a- 
bout the groins. Watery ophthalmies of a chronic 
character, with pains; fungous excrescences of 
the eyelids, externally and mternally,called fici, 
which destroyed the sight of many persons. 
There were fungous growths, in many other in- 
stances, on ulcers, especially on those seated on 
the genital organs. There were many attacks of 
carbuncle (anthrax) through the summer, and 
other affections, which are called "the putrefac- 
tion" (scps)\ also large ecthymata, and large 
tetters (hcrptes) in many instances. 

8. And many and serious complaints attacked 
many persons in the region of the belly. In the 
first place, tenesmus, accompanied with pain, 
attacked many, but more especially children, 
and all who had not attained to puberty; and 
the most of these died. There were many cases 
of lientery and of dysentery; but these were not 
attended with much pain. The evacuations were 
bilious, and fatty, and thin, and watery; in many 
instances the disease terminated in this way, 
with and without fever; there were painful tor- 
mina and volvuli of a malignant kind; copious 
evacuations of the contents of the guts, and yet 
much remained behind; and the passages did 
not carry off the pains, but yielded with dif- 
ficulty to the means administered; for in most 
cases purgings were hurtful to those affected in 
this manner; many died speedily, but in many 
others they held out longer. In a word, all died, 
both those who had acute attacks and those who 
had chronic, most especially from affections of 
the belly, for it was the belly which carried them 
all off. 

9. All persons had an aversion to food in all 
the afore-mentioned complaints to a degree such 



as I never met with before, and persons in these 
complaints most especially, and those recover- 
ing from them, and in all other diseases of a 
mortal nature. Some were troubled with thirst, 
and some not; and both in febrile complaints 
and in others no one drank unseasonably or dis- 
obeyed injunctions. 

10. The urine in many cases was not in pro- 
portion to the drink administered, but greatly 
in excess; and the badness of the urine voided 
was great, for it had not the proper thickness, 
nor concoction, nor purged properly; for in 
many cases purgings by the bladder indicate 
favorably, but in the greatest number they in- 
dicated a melting of the body, disorder of the 
bowels, pains, and a want of crisis. 

1 1. Persons laboring under phrenitis andcau- 
sus were particularly disposed to coma; but al- 
so in all other great diseases which occurred 
along with fever. In the main, most cases were 
attended either by heavy coma, or by short and 
light sleep. 

12. And many other forms of fevers were then 
epidemic, of tertian, of quartan, of nocturnal, 
of continual, of chronic, of erratic, of fevers at- 
tended with nausea, and of irregular fevers. All 
these were attended with much disorder, for the 
bowels in most cases were disordered, accom- 
panied with rigors, sweats not of a critical char- 
acter, and with the state of the urine as de- 
scribed. In most instances the disease was pro- 
tracted, for neither did the deposits which took 
place prove critical as in other cases; for in all 
complaints and in all cases there was difficulty 
of crisis, want of crisis, and protraction of the 
disease, but most especially in these. A few had 
the crisis about the eightieth day, but in most 
instances it (the disease?) left them irregularly. 
A few of them died of dropsy without being 
confined to bed. And in many other diseases 
people were troubled with swelling, but more 
especially in phthisical cases. 

13. The greatest and most dangerous disease, 
and the one that proved fatal to the greatest num- 
ber, was the consumption. With many persons 
it commenced during the winter, and of these 
some were confined to bed, and others bore up 
on foot; the most of those died early in spring 
who were confined to bed; of the others, the 
cough left not a single person, but it became 
milder through the summer; during the au- 
tumn, all these were confined to bed, and many 
of them died, but in the greater number of cases 
the disease was long protracted. Most of these 
were suddenly attacked with these diseases, hav- 
ing frequent rigors, often continual and acute 



Of the Epidemics 



fevers; unseasonable, copious, and cold sweats 
throughout; great coldness, from which they 
had great difficulty in being restored to heat; 
the bowels variously constipated, and again im- 
mediately in a loose state, but towards the ter- 
mination in all cases with violent looseness of 
the bowels; a determination downwards of all 
matters collected about the lungs; urine exces- 
sive, and not good; troublesome melting. The 
coughs throughout were frequent, and sputa co- 
pious, digested, and liquid, but not brought up 
with much pain; and even when they had some 
slight pain, in all cases the purging of the matters 
about the lungs went on mildly. The fauces were 
not very irritable, nor were they troubled with 
any saltish humors; but there were viscid, white, 
liquid, frothy, and copious defluxions from the 
head. But by far the greatest mischief attending 
these and the other complaints, was the aver- 
sion to food, as has been described. For neither 
had they any relish for drink along with their 
food, but continued without thirst. There was 
heaviness of the body, disposition to coma, in 
most cases swelling, which ended in dropsy; 
they had rigors, and were delirious towards 
death. 

14. The form of body peculiarly subject to 
phthisical complaints was the smooth, the whit- 
ish, that resembling the lentil; the reddish, the 
blue-eyed, the leucophlegmatic, and that with 
the Ljapulae having the appearance of wings: 
and women in like manner, with regard to the 
melancholic and subsanguineous,phrenitic and 
dysenteric aflections principally attacked them. 
Tenesmus troubled young persons of a phleg- 
matic temperament. Chronic diarrhoea, acrid 
and viscid discharges from the bowels, attacked 
those who were troubled with bitter bile. 

15. To all those which have been described, 
the season of spring was most inimical, and 
proved fatal to the greatest numbers: the sum- 
mer was the most favorable to them, and the 
fewest died then; inautumn, and underthePlei- 
ades, again there died great numbers.lt appears 
to me, according to the reason of things, that 
the coming on of summer should have done 
good in these cases; for winter coming on cures 
the diseases of summer, and summer coming 
on removes the diseases of winter. And yet the 
summer in question was not of itself well con- 
stituted, for it became suddenly hot, southerly, 
and calm; but, notwithstanding, it proved bene- 
ficial by producing a change on the other con- 
stitution. 

1 6. 1 look upon it as being a great part of the 
art to be able to judge properly of that which 



59 

has been written. For he that knows and makes 
a proper use of these things, would appear to 
me not likely to commit any great mistake in 
the art. He ought to learn accurately the con- 
stitution of every one of the seasons, and of the 
diseases; whatever that is common in each con- 
stitution and disease is good, and whatever is 
bad; whatever disease will be protracted and 
end in death, and whatever will be protracted 
and end in recovery; which disease of an acute 
nature will end in death, and which in recovery. 
From these it is easy to know the order of the 
critical days, and prognosticate from them ac- 
cordingly. And toa person who is skilled in these 
things, it is easy to know to whom, when, and 
how aliment ought to be administered. 

Sixteen Cases of Disease 

CASE I. In Thasus, the Parian who lodged a- 
bove the Temple of Diana was seized with an 
acute fever, at first of a continual and ardent 
t',pe; thirsty, inclined to be comatose at first, 
and afterwards troubled with insomnolency; 
bowels disordered at the beginning, urine thin. 
On the sixth day, passed oily urine, was deliri- 
ous. On the seventh, all the symptoms were ex- 
acerbated; had no sleep, but the urine of the 
same characters, and the understanding disor- 
dered; alvine dejections bilious and fatty. On 
the eighth, a slight epistaxis; small vomiting of 
verdigris-green matters; slept a little. On the 
ninth, in the same state. On the tenth, all the 
symptoms gave way. On the eleventh, he sweat- 
ed, but not over the whole body; he became 
cold, but immediately recovered his heat again. 
On the fourteenth, acute fever; discharges bili- 
ous, thin, and copious; substances floating in 
the urine; he became incoherent. On the seven- 
teenth, in a painful state, for he had no sleep, 
and the fever was more intense. On the twenti- 
eth, sweated all over; apyrexia, dejections bil- 
ious; aversion to food, comatose. On the twenty- 
fourth, had a relapse. On the thirty-fourth, apy- 
rexia; bowels not confined; and he again re- 
covered his heat. Fortieth, apyrexia, bowels con- 
fined for no long time, aversion to food; had 
again slight symptoms of fever, and through- 
out in an irregular form; apyrexia at times, and 
at others not; for if the fever intermitted, and 
was alleviated for a little, it immediately re- 
lapsed again; he used much and improper food; 
sleep bad; about the time of the relapse he was 
delirious; passed thick urine at that time, but 
troubled, and of bad characters; bowels at first 
confined, and again loose; slight fevers of a con- 
tinual type; discharges copious and thin. On the 



60 Hippocrates 

hundred and twentieth day he died. In this pa- 
tient the bowels were constantly from the first 
either loose, with bilious, liquid, and copious de- 
jections, or constipated with hot and undigested 
faeces; the urine throughout bad; for the most 
part coma, or insomnolency with pain; con- 
tinued aversion to food. Ardent fever. 

Explanation of the characters. It is probable 
that the weakness produced by the fever, the 
phrenitis, and affection of the hypochondrium 
caused death on the hundred and twentieth day. 

CASE II. In Thasus, the woman who lodged 
near the Cold Water, on the third day after de- 
livery of a daughter, the lochial discharge not 
taking place, was seized with acute fever, ac- 
companied with rigors. But a considerable time 
before delivery she was feverish, confined to 
bed, and loathed her food. After the rigor which 
took place, continual and acute fevers, with rig- 
ors. On the eighth and following days, was very 
incoherent, and immediately afterwards became 
collected; bowels disordered, with copious, thin, 
watery, and bilious stools; no thirst. On the 
eleventh was collected, but disposed to coma; 
urine copious, thin, and black; no sleep. On the 
twentieth, slight chills, and immediately after- 
wards was warm; slight incoherence; no sleep; 
with regard to the bowels, in the same condi- 
tion; urine watery, and copious. On the twenty- 
seventh, free from fever; bowels constipated; 
not long afterwards violent pain of the right 
hip-joint for a considerable time; fevers after- 
wards supervened; urine watery. On the forti- 
eth, complaints about the hip-joint better; con- 
tinued coughs, with copious, watery sputa ; bow- 
els constipated; aversion to food ; urine the same; 
fever not leaving her entirely, but having par- 
oxysms in an irregular form, sometimes present, 
sometimes not. On the sixtieth, the coughs left 
her without a crisis, for no concoction of the 
sputa took place, nor any of the usual abscesses; 
jaw on the right side convulsively retracted; 
comatose, was again incoherent, and immedi- 
ately became collected; utter aversion to food; 
the jaw became relaxed ; al vine discharges small, 
and bilious; fever more acute, affected with rig- 
ors; on the following days lost her speech, and 
again became collected, and talked. On the 
eightieth she died. In this case the urine through- 
out was black, thin, and watery; coma super- 
vened; there was aversion to food, desponden- 
cy, and insomnolency; irritability, restlessness; 
she was of a melancholic turn of mind. 

Explanation of the characters. It is probable 
that the suppression of the lochial discharge 
caused death on the eightieth day. 



CASE III. InThasus,Pythion, who was lodged 
above the Temple of Hercules, from labor, fa- 
tigue, and neglected diet, was seized with strong 
rigor and acute fever; tongue dry, thirsty, and 
bilious; had no sleep; urine darkish, eneorema 
floating on the top of the urine, did not subside. 
On the second day, about noon, coldness of 
the extremities, especially about the hands and 
head; loss of speech and of articulation; breath- 
ing short for a considerable time; recovered his 
heat; thirst; passed the night quietly; slight 
sweats about the head. On the third, passed the 
day in a composed state; in the evening, about 
sunset, slight chills; nausea, agitation; passed 
the night in a painful state; had no sleep; small 
stools of compact faeces passed from the bowels. 
On the fourth, in the morning, composed; a- 
bout noon all the symptoms became exacerbat- 
ed; coldness, loss of speech, and of articulation; 
became worse; recovered his heat after a time; 
passed black urine, having substances floating 
in it; the night quiet; slept. On the fifth, seemed 
to be lightened, but a painful weight about the 
belly; thirsty, passed the night in a painful state. 
On the sixth, in the morning, in a quiet state; 
in the evening the pains greater; had a parox- 
ysm; in the evening the bowels properly opened 
by a small clyster; slept at night. On the seventh, 
during the day, in a state of nausea, somewhat 
disturbed; passed urine of the appearance of oil; 
at night, much agitation, was incoherent, did 
not sleep. On the eighth, in the morning, slept 
a little;but immediately coldness, loss of speech, 
respiration small and weak; but in the evening 
recovered his heat again; was delirious, but to- 
wards day was somewhat lightened ; stools small, 
bilious, and unmixed. On the ninth, affected 
with coma, and with nausea when roused; not 
very thirsty; about sunset he became restless and 
incoherent; passed a bad night. On the tenth, in 
the morning, had become speechless; great cold- 
ness; acute fever; much perspiration; he died. 
His sufferings were on the even days. 

Explanation of the characters. It is probable 
that the excessive sweats caused death on the 
tenth day. 

CASE IV. The patient affected with phrenitis, 
having taken to bed on the first day, vomited 
largely of verdigris-green and thin matters; fe- 
ver, accompanied with rigors, copious and con- 
tinued sweats all over; heaviness of the head 
and neck, with pain; urine thin, substances float- 
ing in the urine small, scattered, did not sub- 
side; had copious dejections from the bowels; 
very delirious; no sleep. On the second, in the 
morning,loss of speech; acute fever; he sweated, 



Of the Epidemics 



61 



fever did not leave him; palpitations over the 
whole body, at night, convulsions. On the third, 
all the symptoms exacerbated; he died. 

Explanation of the characters. It is probable 
that the sweats and convulsions caused death. 

CASE V. In Larissa,a man, who was bald, sud- 
denly was seized with pain in the right thigh; 
none of the things which were administered 
did him any good. On the first day, fever acute, 
of the ardent type, not agitated, but the pains 
persisted. On the second, the pains in the thigh 
abated, but the fever increased; somewhat tos- 
sed about; did not sleep; extremities cold; pas- 
sed a large quantity of urine, not of a good 
character. On the third, the pain of the thigh 
ceased; derangement of the intellect, confusion, 
and much tossing about. On the fourth, about 
noon, he died. An acute disease. 

CASE VI. In Abdera, Pericles was seized with 
a fever of the acute, continual type, with pain; 
much thirst, nausea, could not retain his drink; 
somewhat swelled about the spleen, with heavi- 
ness of the head. On the first day, had hemor- 
rhage from the left nostril, but still the fever be- 
came more violent; passed much muddy, white 
urine, which when allowed to stand did not 
subside. On the second day, all the symptoms 
were exacerbated, yet the urine was thick, and 
more inclined to have a sediment; the nausea 
less; he slept. On the third, fever was milder; 
abundance of urine, which was concocted, and 
had a copious sediment; passed a quiet night. 
On the fourth, had a copious and warm sweat 
all over about noon; was free of fever, had a 
crisis, no relapse. An acute affection. 

CASE VII. In Abdera, the young woman who 
was lodged in the Sacred Walk was seized with 
an ardent fever. She was thirsty, and could not 
sleep; had menstruation for the first time. On 
the sixth, much nausea, flushing, was chilly, 
and tossed about. On the seventh, in the same 
state; urine thin, but of a good color; no disturb- 
ance about the bowels. On the eighth, deaf- 
ness, acute fever, insomnolency, nausea, rigors, 
became collected; urine the same. On the ninth, 
in the same state, and also on the following days; 
thus the deafness persisted. On the fourteenth, 
disorder of the intellect; the fever abated. On 
the seventeenth, a copious hemorrhage from the 
nose; the deafness slightly better; and on the 
following days, nausea, deafness, and incoher- 
ence. On the twentieth, pain of the feet; deaf- 
ness and delirium left her; a small hemorrhage 
from the nose; sweat, apyrexia. On the twenty- 
fourth, the fever returned, deafness again; pain 
of the feet remained; incoherence. On the twen- 



ty-seventh, had a copious sweat, apyrexia; the 
deafness left her; the pain of her feet partly re- 
mained; in other respects had a complete crisis. 

Explanation of the characters. It is probable 
that the restoration of health on the twentieth 
day was the result of the evacuation of urine. 

CASE VIII. In Abdera, Anaxion, who was 
lodged near the Thracian Gates, was seized with 
an acute fever; continued pain of the right side; 
dry cough, without expectoration during the 
first days, thirst, insomnolency; urine well col- 
ored, copious, and thin. On the sixth, delirious; 
no relief from the warm applications. On the 
seventh, in a painful state, for the fever increased, 
while the pains did not abate, and the cough 
was troublesome, and attended with dyspnoea. 
On the eighth, I opened a vein at the elbow, 
and much blood, of a proper character, flowed; 
the pains were abated, but the dry coughs con- 
tinued. On the eleventh, the fever diminished; 
slight sweats about the head; coughs, with more 
liquid sputa; he was relieved. On the twentieth, 
sweat, apyrexia; but after the crisis he was thirs- 
ty, and the expectorations were not good. On the 
twenty-seventh the fever relapsed; he coughed, 
and brought up much concocted sputa: sedi- 
ment in the urine copious and white; he be- 
came free of thirst, and the respiration was good. 
On the thirty-fourth, sweated all over, apyrexia, 
general crisis. 

Explanation of the characters. It is probable 
that the evacuation of the sputa brought about 
the recovery on the thirty-fourth day. 

CASE IX. In Abdera, Heropythus, while still 
on foot, had pain in the head, and not long 
afterwards he took to bed; he lived near the 
High Street. Was seized with acute fever of 
the ardent type; vomitings at first of much bil- 
ious matter; thirst; great restlessness; urine thin, 
black, substances sometimes floating high in it, 
and sometimes not; passed the night in a pain- 
ful state; paroxysms of the fever diversified, and 
for the most part irregular. About the four- 
teenth day, deafness; the fever increased; urine 
the same. On the twentieth and following days, 
much delirium. On the thirtieth, copious hem- 
orrhage from the nose, and became more col- 
lected; deafness continued, but less; the fever 
diminished; on the following days, frequent 
hemorrhages, at short intervals. About the sixti- 
eth, the hemorrhages ceased, but violent pain 
of the hip-joint, and increase of fever. Not long 
afterwards, pains of all the inferior parts; it then 
became a rule, that either the fever and deaf- 
ness increased, or, if these abated and were light- 
ened, the pains of the inferior parts were in- 



61 Hippocrates 

creased. About the eightieth day, all the com- 
plaints gave way, without leaving any behind; 
for the urine was of a good color, and had a co- 
pious sediment, while the delirium became less. 
About the hundredth day, disorder of the bow- 
els, with copious and bilious evacuations, and 
these continued for a considerable time, and a- 
gain assumed the dysenteric form with pain; 
but relief of all the other complaints. On the 
whole, the fevers went off, and the deafness 
ceased. On the hundred and twentieth day, had 
a complete crisis. Ardent fever. 

Explanation of the characters. It is probable 
that the bilious discharge brought about the re- 
covery on the hundred and twentieth day. 

CASE X. In Abdera, Nicodemus was seized 
with fever from venery and drinking. At the 
commencement he was troubled with nausea 
and cardialgia; thirsty, tongue was parched; 
urine thin and dark. On the second day, the 
fever exacerbated; he was troubled with rigors 
and nausea; had no sleep; vomited yellow bile; 
urine the same; passed a quiet night, and slept. 
On the third, a general remission; amelioration; 
but about sunset felt again somewhat uncom- 
fortable; passed an uneasy night. On the fourth, 
rigor, much fever, general pains; urine thin, 
with substances floating in it; again a quiet night. 
On the fifth, all the symptoms remained, but 
there was an amelioration. On the sixth, some 
general pains; substances floating in the urine; 
very incoherent. On the seventh, better. On the 
eighth, all the other symptoms abated. On the 
tenth, and following days, there were pains, but 
all less; in this case throughout, the paroxysms 
and pains were greater on the even days. On 
the twentieth, the urine white and thick, but 
when allowed to stand had no sediment; much 
sweat; seemed to be free from fever; but again 
in the evening he became hot, with the same 
pains, rigor, thirst, slightly incoherent. On the 
twenty-fourth, urine copious, white, with an 
abundant sediment; a copious and warm sweat 
all over; apyrexia; the fever came to its crisis. 

Explanation of the characters. It is probable 
that the cure was owing to the bilious evacua- 
tions and the sweats. 

CASE XI. In Thasus, a woman, of a melan- 
cholic turn of mind, from some accidental cause 
of sorrow, while still going about, became af- 
fected with loss of sleep, aversion to food, and 
had thirst and nausea. She lived near the Py- 
lates, upon the Plain. On the first, at the com- 
mencement of night, frights, much talking, de- 
spondency, slight fever; in the morning, fre- 
quent spasms, and when they ceased, she was 



incoherent and talked obscurely; pains frequent, 
great, and continued. On the second, in the same 
state; had no sleep; fever more acute. On the 
third, the spasms left her; but coma, and dis- 
position to sleep, and again awaked, started up, 
and could not contain herself; much incoher- 
ence; acute fever; on that night a copious sweat 
all over; apyrexia, slept, quite collected; had a 
crisis. About the third day, the urine black, thin, 
substances floating in it generally round, did 
not fall to the bottom; about the crisis a copious 
menstruation. 

CASE XII. In Larissa, a young unmarried 
woman was seized with a fever of the acute and 
ardent type; insomnolency, thirst; tongue sooty 
and dry; urine of a good color, but thin. On the 
second, in an uneasy state, did not sleep. On the 
third, alvine discharges copious, watery, and 
greenish, and on the following days passed such 
with relief. On the fourth, passed a small quan- 
tity of thin urine, having substances floating to- 
wards its surface, which did not subside; was 
delirious towards night. On the sixth, a great 
hemorrhage from the nose; a chill, with a copi- 
ous and hot sweat all over; apyrexia, had a cri- 
sis. In the fever, and when it had passed the cri- 
sis, the menses took place for the first time, for 
she was a young woman. Throughout she was 
oppressed with nausea, and rigors; redness of 
the face; pain of the eyes; heaviness of the head; 
she had no relapse, but the fever came to a cri- 
sis. The pains were on the even days. 

CASE XIII. Apollonius, in Abdera, bore up 
(under the fever?) for some time, without be- 
taking himself to bed. His viscera were enlarged, 
and for a considerable time there was a con- 
stant pain about the liver, and then he became 
affected with jaundice; he was flatulent, and of 
a whitish complexion. Having eaten beef, and 
drunk unseasonably, he became a little heated 
at first, and betook himself to bed, and having 
used large quantities of milk, that of goats and 
sheep, and both boiled and raw, with a bad diet 
otherwise, great mischief was occasioned by all 
these things; for the fever was exacerbated, and 
of the food taken scarcely any portion worth 
mentioning was passed from the bowels; the 
urine was thin and scanty; no sleep; troublesome 
meteorism; much thirst; disposition to coma; 
painful swelling of the right hypochondrium; 
extremities altogether coldish; slight incoher- 
ence, forgetfulness of everything he said; he was 
beside himself. About the fourteenth day after 
he betook himself to bed, had a rigor, became 
heated, and was seized with furious delirium; 
loud cries, much talking, again composed, and 



On Injuries of the Head 



then coma came on; afterwards the bowels dis- 
ordered, with copious, bilious, unmixed, and 
undigested stools; urine black, scanty, and thin; 
much restlessness; alvinc evacuations of varied 
characters, either black, scanty, and verdigris- 
green, or fatty, undigested, and acrid; and at 
times the dejections resembled milk. About the 
twenty-fourth, en joyed a calm; other matters in 
the same state; became somewhat collected; re- 
membered nothing that had happened since he 
was confined to bed; immediately afterwards 
became delirious; every symptom rapidly get- 
ting worse. About the thirtieth, acute fever; 
stools copious and thin; was delirious; extremi- 
ties cold; loss of speech. On the thirty-fourth he 
died. In this case, as far as I saw, the bowels 
were disordered; urine thin and black; disposi- 
tion to coma; insomnolency; extremities cold; 
delirious throughout. Phrenitis. 

CASE XIV. In Cyzicus, a woman who had 
brought forth twin daughters, after a difficult 
labor, and in whom the lochial discharge was 
insufficient, at first was seized with an acute 
fever, attended with chills; heaviness of the head 
and neck, with pain; insomnolency from the 
commencement; she was silent, sullen, and dis- 
obedient; urine thin, and devoid of color; thirst, 
nausea for the most part; bowels irregularly dis- 
ordered, and again constipated. On the sixth, 
towards night, talked much incoherently; had 
no sleep. About the eleventh day was seized 
with wild delirium, and again became collected; 
urine black, thin, and again deficient, and of an 
oily appearance; copious, thin, and disordered 
evacuations from the bowels. On the fourteenth, 
frequent convulsions; extremities cold; not in 
anywise collected; suppression of urine. On the 
sixteenth loss of speech. On the seventeenth, she 
died. Phrenitis. 

Explanation of the characters. It is probable 
that death was caused, on the seventeenth day, 
by the affection of the brain consequent upon 
her accouchement. 

CASE XV.InThasus, the wife of Dealces,who 
was lodged upon the Plain, from sorrow was 



seized with an acute fever, attended with chills. 
From first to last she wrapped herself up in 
her bedclothes; still silent, she fumbled, picked, 
bored, and gathered hairs (from them); tears, 
and again laughter; no sleep; bowels irritable, 
but passed nothing; when directed, drank a 
little; urine thin and scanty; to the touch of the 
hand the fever was slight; coldness of the ex- 
tremities. On the ninth, talked much incoher- 
ently, and again became composed and silent. 
On the fourteenth, breathing rare, large, at in- 
tervals; and again hurried respiration. On the 
sixteenth, looseness of the bowels from a stimu- 
lant clyster; afterwards she passed her drink, 
nor could retain anything, for she was com- 
pletely insensible; skin parched and tense. On 
the twentieth, much talk, and again became 
composed; loss of speech; respiration hurried. 
On the twenty-first she died. Her respiration 
throughout was rare and large; she was total- 
ly insensible; always wrapped up in her bed- 
clothes; either much talk, or completely silent 
throughout. Phrenitis. 

CASE XVI. In Meliboea, a young man having 
become heated by drinking and much venery, 
was confined to bed; he was affected with rig- 
ors and nausea; insomnolency and absence of 
thirst. On the first day much faeces passed from 
the bowels along with a copious flux; and on the 
following days he passed many watery stools of 
a green color; urine thin, scanty, and deficient 
in color; respiration rare, large, at long inter- 
vals; softish distention of the hypochondrium, 
of an oblong form, on both sides; continued pal- 
pitation in the epigastric region throughout; 
passed urine of an oily appearance. On the tenth, 
he had calm delirium, for he was naturally of 
an orderly and quiet disposition; skin parched 
and tense; dejections either copious and thin, 
or bilious and fatty. On the fourteenth, all the 
symptoms were exacerbated; he became deliri- 
ous, and talked much incoherently. On the twen- 
tieth, wild delirium, jactitation, passed no urine; 
small drinks were retained. On the twenty- 
fourth he died. Phrenitis. 



On Injuries of the Head 



MEN'S heads are by no means all like to one 
another, nor are the sutures of the head of all 
men constructed in the same form. Thus, who- 
ever has a prominence in the anterior part of 
the head (by prominence is meant the round 
protuberant part of the bone which projects be- 



yond the rest of it), in him the sutures of the 
head take the form of the Greek letter tau, T; 
for the head has the shorter line running trans- 
verse before the prominence, while the other 
line runs through the middle of the head, all 
the way to the neck. But whoever has the prom- 



Hippocrates 



incncc in the back part of the head, in him the 
sutures are constructed in quite the opposite 
form to the former; for in this case the shorter 
line runs in front of the prominence, while the 
longer runs through the middle all along to the 
forehead. But whoever has a prominence of the 
head both before and behind, in him the su- 
tures resemble the Greek letter eta H; for the 
long lines of the letter run transverse before each 
prominence while the short one runs through 
the middle and terminates in the long lines. 
But whoever has no prominence on either part 
he has the sutures of the head resembling the 
Greek letter x; for the one line conies transverse 
to the temple while the other passes along the 
middle of the head. The bone at the middle of 
the head is double, the hardest and most com- 
pact part being the upper portion, where it is 
connected with the skin, and the lowest, where 
it is connected with the meninx (dura mater); 
and from the uppermost and lowermost parts 
the bone gradually becomes softer and less com- 
pact, till you come to the diploe. The diploe is 
the most porous, the softest, and most cavern- 
ous part. But the whole bone of the head, with 
the exception of a small portion of the upper- 
most and lowermost portions of it, is like a 
sponge; and the bone has in it many juicy sub- 
stances, like caruncles; and if one will rub them 
with the fingers, some blood will issue from 
them. There are also in the bone certain very 
slender and hollow vessels full of blood. So it is 
with regard to hardness, softness, and porosity. 
2. In respect to thickness and thinness; the 
thinnest and weakest part of the whole head is 
the part about the bregma; and the bone there 
has the smallest and thinnest covering of flesh 
upon it, and the largest proportion of brain is 
situated in that region of the head. And hence 
it happens that from similar or even smaller 
wounds and instruments, when a person is 
wounded to the same or a less degree, the bone 
of the head there is more contused, fractured, 
and depressed; and that injuries there are more 
deadly and more difficult to cure; and it is more 
difficult to save one's life in injuries there than 
in any other part of the head; that from having 
sustained a similar or even a less wound a man 
will die, and that, too, in a shorter space of time 
than from a wound in any other part of the 
head. For the brain about the bregma feels 
more quickly and strongly any mischief that 
may occur to the flesh or the bone; for the brain 
about the bregma is in largest quantity, and is 
covered by the thinnest bone and the least flesh. 
Of the other portions, the weakest is that about 



the temples; for it is the conjunction of the 
lower jaw with the cranium, and there is mo- 
tion there up and down as at a joint; and the 
organ of hearing is near it; and further, a hol- 
low and important vein runs along the temple. 
But the whole bone of the head behind the ver- 
tex and the ear is stronger than the whole an- 
terior part, and the bone itself has a larger and 
deeper covering of flesh upon it. And hence it 
follows, that when exposed to the same or even 
greater injuries from instruments of the same 
or greater size, the bone is less liable to be frac- 
tured and depressed than elsewhere; and that 
in a fatal accident the patient will live longer 
when the wound is in the posterior part of the 
head than when elsewhere; and that pus takes 
longer time to form and penetrate through the 
bone to the brain, owing to the thickness of the 
bone; and moreover, as there is less brain in 
that part of the head, more persons who are 
wounded in the back part of the head escape 
than of those who are wounded in the anterior 
part. And in fatal cases, a man will survive 
longer in winter than in summer, whatever be 
the part of the head in which the wound is 
situated. 

3. As to the hcedrce (dints or marks?) of 
sharp and light weapons, when they take place 
in the bone without fissure, contusion, or de- 
pression inwards (and these take place equally 
in the anterior and posterior part of the head), 
death, when it does occur, does not properly re- 
sult from them. A suture appearing in a wound, 
when the bone is laid bare, on whatever part of 
the head the wound may have been inflicted, is 
the weakest point of the head to resist a blow or 
a weapon, when the weapon happens to be im- 
pinged into the suture itself; but more especial- 
ly when this occurs in the bregma at the weak- 
est part of the head, and the sutures happen to 
be situated near the wound, and the weapon 
has hit the sutures themselves. 

4. The bone in the head is liable to be wound- 
ed in the following modes, and there are many 
varieties in each of these modes of fracture: 
When a wounded bone breaks, in the bone 
comprehending the fissure, contusion neces- 
sarily takes place where the bone is broken; for 
an instrument that breaks the bone occasions a 
contusion thereof more or less, both at the frac- 
ture and in the parts of the bone surrounding 
the fracture. This is the first mode. But there 
are all possible varieties of fissures; for some of 
them are fine, and so very fine that they can- 
not be discovered, either immediately after the 
injury, or during the period in which it would 



On Injuries of the Head 



be of use to the patient if this could be ascer- 
tained. And some of these fissures are thicker 
and wider, certain of them being very wide. 
And some of them extend to a greater, and some 
to a smaller, distance. And some are more 
straight, nay, completely straight; and some 
are more curved, and that in a remarkable de- 
gree. And some are deep, so as to extend down- 
wards and through the whole bone; and some 
are less so, and do not penetrate through the 
whole bone. 

5. But a bone may be contused, and yet remain 
in its natural condition without any fracture in 
it; this is the second mode. And there are many 
varieties of contusion; for they occur to a great- 
er or less degree, and to a greater depth, so as 
sometimes to extend through the whole bone; 
or to a less depth, so as not to extend through 
the whole bone; and to a greater and smaller 
length and breadth. But it is not possible to rec- 
ognize any of these varieties by the sight, so as 
to determine their form and extent; neither, in- 
deed, is it visible to the eyes when any mischief 
of this kind takes place, and immediately after 
the injury, whether or not the bone has been ac- 
tually bruised, as is likewise the case with cer- 
tain fractures at a distance from the seat of in- 
jury. 

6. And the bone being fractured, is sometimes 
depressed inwards from its natural level along 
with the fractures, otherwise there would be no 
depression; for the depressed portion being frac- 
tured and broken oft is pushed inwards, while 
the rest of the bone remains in its natural posi- 
tion; and in this manner a fracture is combined 
with the depression. This is the third mode. 
There are many varieties of depression, for it 
may comprehend a greater and a small extent 
of bon, and may either be to a greater depth, 
or less so, and more superficial. 

7. When a hedra, or dint of a weapon, takes 
place in a bone, there may be a fracture com- 
bined with it; and provided there be a fracture, 
contusion must necessarily be joined, to a great- 
er or less extent, in the seat of the dint and frac- 
ture, and in the bone which comprehends them. 
This is the fourth mode. And there may be a 
hedra, or indentation of the bone, along with 
contusion of the surrounding bone, but without 
any fracture either in the hedra or in the contu- 
sion inflicted by the weapon. But the indenta- 
tion of a weapon takes place in a bone, and is 
called hedra, when the bone remaining in its 
natural state, the weapon which struck against 
the bone leaves its impression on the part which 
it struck. In each of these modes there are many 



varieties, with regard to the contusion and frac- 
ture, if both these be combined with the hedra, 
or if contusion alone, as it has been already stated 
that there are many varieties of contusion and 
fracture. And the hedra, or dint, of itself may 
be longer and shorter, crooked, straight, and 
circular; and there are many varieties of this 
mode, according to the shape of the weapon; t 
and they may be more or less deep, and narrow-' 
er or broader, and extremely broad. When a 
part is cleft, the cleft or notch which occurs in 
the bone, to whatever length or breadth, is a 
hedra, if the other bones comprehending the 
cleft remain in their natural position, and be 
not driven inwards; for in this case it would be 
a depression, and no longer a hedra. 

8. A bone may be injured in a different part 
of the head from that on which the person has 
received the wound, and the bone has been laid 
bare. This is the fifth mode. And for this mis- 
fortune, when it occurs, there is no remedy; for 
when this mischief takes place, there is no means 
of ascertaining by any examination whether or 
not it has occurred, or on what part of the head. 

9. Of these modes of fracture, the following 
require trepanning: the contusion, whether the 
bone be laid bare or not; and the fissure, wheth- 
er apparent or not. And if, when an indentation 
(hedra) by a weapon takes place in a bone it be 
attended with fracture and contusion, and even 
if contusion alone, without fracture, be com- 
bined with the indentation, it requires trepan- 
ning. A bone depressed from its natural position 
rarely requires trepanning; and those which 
are most pressed and broken require trepanning 
the least; neither does an indentation (hedra) 
without fracture and contusion require trepan- 
ning; nor does a notch, provided it is large and 
wide; for a notch and a hedra are the same. 

10. In the first place, one must examine the 
wounded person, in what part of the head the 
wound is situated, whether in the stronger or 
weaker parts; and ascertain respecting the hairs 
about the wound, whether they have been cut 
ofT by the instrument, and have gone into the 
wound; and if so, one should declare that the 
bone runs the risk of being denuded of flesh, 
and of having sustained some injury from the 
weapon. These things one should say from a dis- 
tant inspection, and before laying a hand on the 
man; but on a close examination one should en- 
deavor to ascertain clearly whether the bone be 
denuded of flesh or not; and if the denuded bone 
be visible to the eyes, this will be enough; but 
otherwise an examination must be made with the 
sound. And if you find the bone denuded of the 



66 Hippocrates 

flesh, and not safe from the wound, you must 
first ascertain the state of the bone, and the ex- 
tent of the mischief, and of what assistance it 
stands in need. One should also inquire of the 
wounded person how and in what way he sus- 
tained the injury; and if it be not apparent 
whether the bone has sustained an injury or 
not, it will be still more necessary, provided the 
bone be denuded, to make inquiry how the 
wound occurred, and in what manner; for 
when contusions and fractures exist in the bone, 
but are not apparent, we must ascertain, in the 
first place from the patient's answers, whether 
or not the bone has sustained any such injuries, 
and then find out the nature of the case by word 
and deed, with the exception of sounding. For 
sounding does not discover to us whether the 
bone has sustained any of these injuries or not; 
but sounding discovers to us an indentation in- 
flicted by a weapon, and whether a bone be de- 
pressed from its natural position, and whether 
the bone be strongly fractured; all which may 
also be ascertained visibly with the eyes. 

ii. And a bone sustains fractures, either so 
fine as to escape the sight, or such as are appar- 
ent, and contusions which are not apparent, and 
depression from its natural position, especially 
when one person is intentionally wounded by 
another, or when, whether intentionally or not, 
a blow or stroke is received from an elevated 
place, and if the instrument in the hand, wheth- 
er used in throwing or striking, be of a power- 
ful nature, and if a stronger person wound a 
weaker. Of those who are wounded in the 
parts about the bone, or in the bone itself, by a 
fall, he who falls from a very high place upon 
a very hard and blunt object is in most danger 
of sustaining a fracture and contusion of the 
bone, and of having it depressed from its nat- 
ural position; whereas he that falls upon more 
level ground, and upon a softer object, is likely 
to suffer less injury in the bone, or it may not 
be injured at all. Of those instruments which, 
falling upon the head, wound the parts about 
the bone, or the bone itself, that which falls 
from a very high place, and the least on a level 
with the person struck, and which is at the same 
time very hard, very blunt, and very heavy, and 
which is the least light, sharp, and soft, such an 
instrument would occasion a fracture and con- 
tusion of the bone. And there is most danger 
that the bone may sustain these injuries, under 
such circumstances, when the wound is direct 
and perpendicular to the bone, whether struck 
from the hand or from a throw, or when any 
object falls upon the person, or when he is 



wounded by falling, or in whatever way the 
bone sustains a direct wound from this instru- 
ment. Those weapons which graze the bone 
obliquely are less apt to fracture, contuse, or de- 
press the bone, even when the bone is denuded 
of flesh; for in some of those wounds thus in- 
flicted the bone is not laid bare of the flesh. 
Those instruments more especially produce frac- 
tures in the bone, whether apparent or not, and 
contusions, and inward depression of the bone, 
which are rounded, globular, smooth on all 
sides, blunt, heavy, and hard; and such weapons 
bruise, compress, and pound the flesh; and the 
wounds inflicted by such instruments, whether 
obliquely or circularly, are round, and are more 
disposed to suppurate, and to have a discharge, 
and take longer time to become clean; for the 
flesh which has been bruised and pounded must 
necessarily suppurate and slough away. But 
weapons of an oblong form, being, for the most 
part, slender, sharp, and light, penetrate the 
flesh rather than bruise it, and the bone in like 
manner; and such an instrument may occasion 
a hedra and a cut (for a hedra and a cut are 
same thing); but weapons of this description 
do not produce contusions, nor fractures, nor 
depressions inwardly. And in addition to the ap- 
pearances in the bone, which you can detect by 
the sight, you should make inquiry as to all 
these particulars (for they are symptoms of a 
greater or less injury), whether the wounded 
person was stunned, and whether darkness was 
diffused over his eyes, and whether he had verti- 
go, and fell to the ground. 

12. When the bone happens to be denuded 
of flesh by the weapon, and when the wound 
occurs upon the sutures, it is difficult to distin- 
guish the indentation (hedra) of a weapon 
which is clearly recognized in other parts of the 
bone, whether it exist or not, and especially if 
the hedra be seated in the sutures themselves. 
For the suture being rougher than the rest of 
the bone occasions confusion, and it is not clear 
which is the suture, and which the mark inflict- 
ed by the instrument, unless the latter (hedra) 
be large. Fracture also for the most part is com- 
bined with the indentation when it occurs in the 
sutures; and this fracture is more difficult to 
discern when the bone is broken, on this ac- 
count, that if there be a fracture, it is situated 
for the most part in the suture. For the bone is 
liable to be broken and slackened there, owing 
to the natural weakness of the bone there, and 
to its porosity, and from the suture being readily 
ruptured and slackened: but the other bones 
which surround the suture remain unbroken, 



On Injuries of the Head 



because they are stronger than the suture. For 
the fracture which occurs at the suture is also a 
slackening of the suture, and it is not easy to de- 
tect whether the bone be broken and slackened 
by the indentation of a weapon occurring in 
the suture, or from a contusion of the bone at 
the sutures; but it is still more difficult to detect 
a fracture connected with contusion. For the 
sutures, having the appearance of fissures, elude 
the discernment and sight of the physician, as 
being rougher than the rest of the bone, unless 
the bone be strongly cut and slackened (for a 
cut and a hedra are the same thing). But it is 
necessary, if the wound has occurred at the su- 
tures, and the weapon has impinged on the bone 
or the parts about it, to pay attention and find 
out what injury the bone has sustained. For a 
person wounded to the same, or a much small- 
er, extent, and by weapons of the same size and 
quality, and even much less, will sustain a much 
greater injury, provided he has received the 
blow at the sutures, than if it was elsewhere. 
And many of these require trepanning, but you 
must not apply the trepan to the sutures them- 
selves, but on the adjoining bone. 

13. And with regard to the cure of wounds 
in the head, and the mode of detecting injuries 
in the bone which are not apparent, the follow- 
ing is my opinion: In a wound of the head, 
you must not apply anything liquid, not even 
wine, but as little as possible, nor a cataplasm, 
nor conduct the treatment with tents, nor apply 
a bandage to an ulcer on the head, unless it be 
situated on the forehead, in the part which is 
bare of hairs, or about the eyebrow and eye, for 
wounds occurring there require cataplasms 
and bandages more than upon any other part 
of the head. For the rest of the head surrounds 
the whole forehead, and the wounds wherever 
situated become inflamed and swelled, owing 
to an influx of blood from the surrounding parts. 
And neither must you apply cataplasms and 
bandages to the forehead at all times; but when 
the inflammation is stopped and the swelling 
has subsided, you must give up the cataplasms 
and bandages. A wound in any other part of 
the head must not be treated with tents, band- 
ages, or cataplasms, unless it also requires in- 
cision. You must perform incision on wounds 
situated on the head and forehead, whenever 
the bone is denuded of flesh, and appears to 
have sustained some injury from the blow, but 
the wound has not sufficient length and breadth 
for the inspection of the bone, so that it may be 
seen whether it has received any mischief from 
the blow, and of what nature the injury is, and 



to what extent the flesh has been contused, and 
whether the bone has sustained any injury, or 
whether it be uninjured by the blow, and has 
suffered no mischief; and with regard to the 
treatment, what the wound, and the flesh, and 
the injury of the bone stand in need of. Ulcers 
of this description stand in need of incision; 
and, if the bone be denuded of the flesh, and if 
it be hollow, and extend far obliquely, we cut 
up the cavity wherever the medicine cannot 
penetrate readily, whatever medicine it may be; 
and wounds which are more inclined to be circu- 
lar and hollow, and for the most part others of 
the like shape, are cut up by making a double in- 
cision in the circle lengthways, according to the 
figure of the man, so as to make the wound of 
a long form. Incisions may be practiced with 
impunity on other parts of the head, with the 
exception of the temple and the parts above it, 
where there is a vein that runs across the temple, 
in which region an incision is not to be made. 
For convulsions seize on a person who has been 
thus treated; and if the incision be on the left 
temple, the convulsions seize on the right side; 
and if the incision be on the right side, the con- 
vulsions take place on the left side. 

14. When, then, you lay open a wound in the 
head on account of the bones having been de- 
nuded of the flesh, as wishing to ascertain 
whether or not the bone has received an injury 
from the blow, you must make an incision pro- 
portionate to the size of the wound, and as much 
as shall be judged necessary. And in making 
the incision you must separate the flesh from 
the bone where it is united to the membrane 
(pericranium?) and to the bone, and then fill 
the whole wound with a tent, which will ex- 
pand the wound very wide next day with as 
little pain as possible; and along with the tents 
apply a cataplasm, consisting of a mass (maza) 
of fine flour pounded in vinegar, or boiled so 
as to render it as glutinous as possible. On the 
next day, when you remove the tent, having ex- 
amined the bone to see what injury it has sus- 
tained, if the wound in the bone be not right seen 
by you, nor can you discover what mischief the 
bone itself has sustained, but the instrument 
seems to have penetrated to the bone so as to 
have injured it, you must scrape the bone with 
a raspatory to a depth and length proportionate 
to the suture of the patient, and again in a trans- 
verse direction, for the sake of the fractures 
which are not seen, and of the contusions which 
are not discovered, as not being accompanied 
with depression of the bone from its natural 
position. For the scraping discovers the mis- 



68 



Hippocrates 



chief, if the injuries in the bone be not other- 
wise manifest. And if you perceive an indenta- 
tion (hcdra) left in the bone by the blow, you 
must scrape the dint itself and the surrounding 
bones, lest, as often happens, there should be a 
fracture and contusion, or a contusion alone, 
combined with the dint, and escape observation. 
And when you scrape the bone with the raspa- 
tory, and it appears that the wound in the bone 
requires the operation, you must not postpone 
it for three days, but do it during this period, 
more especially if the weather be hot, and you 
have had the management of the treatment 
from the commencement. If you suspect that the 
bone is broken or contused, or has sustained both 
these injuries, having formed your judgement 
from the severity of the wound, and from the 
information of the patient, as that the person 
who inflicted the wound, provided it was done 
by another person, was remarkably strong, and 
that the weapon by which he was wounded was 
of a dangerous description, and then that the 
man had been seized with vertigo, dimness of 
vision, and stupor, and fell to the ground, 
under these circumstances, if you cannot dis- 
cover whether the bone be broken, contused, or 
both the one and the other, nor can see the 
truth of the matter, you must dissolve the jet- 
black ointment, and fill the wound with it 
when this dissolved, and apply a linen rag 
smeared with oil, and then a cataplasm of the 
maza with a bandage; and on the next day, 
having cleaned out the wound, scrape the bone 
with the raspatory.Andif the bone is not sound, 
but fractured and contused, the rest of it which 
is scraped will be white; but the fracture and 
contusion, having imbibed the preparation, will 
appear black, while the rest of the bone is white. 
And you must again scrape more deeply the 
fracture where it appears black; and, if you 
thus remove the fissure, and cause it to dis- 
appear, you may conclude that there has been 
a contusion of the bone to a greater or less ex- 
tent, which has occasioned the fracture that has 
disappeared under the raspatory; but it is less 
dangerous, and a matter of less consequence, 
when the fissure has been effaced. But if the 
fracture extend deep, and do not seem likely to 
disappear when scraped, such an accident re- 
quires trepanning. But having performed this 
operation, you must apply the other treatment 
to the wound. 

15. You must be upon your guard lest the 
bone sustain any injury from the fleshy parts 
if not properly treated. When the bone has been 
sawed and otherwise denuded, whether it be 



actually sound, or only appears to be so, but 
has sustained some injury from the blow, there 
may be danger of its suppurating (although it 
would not otherwise have done so), if the flesh 
which surrounds the bone be ill cured, and be- 
come inflamed and strangled; for it gets into a 
febrile state, and becomes much inflamed. For 
the bone acquires heat and inflammation from 
the surrounding flesh, along with irritation and 
throbbing, and the other mischiefs which are 
in the flesh itself, and from these it gets into a 
state of suppuration. It is a bad thing for the 
flesh (granulations?) in an ulcer to be moist 
and mouldy, and to require a long time to be- 
come clean. But the wound should be made to 
suppurate as quickly as possible; for, thus the 
parts surrounding the wound would be the 
least disposed to inflammation, and would be- 
come the soonest clean; for the flesh which has 
been chopped and bruised by the blow, must 
necessarily suppurate and slough away. But 
when cleaned the wound must be dried, for thus 
the wound will most speedily become whole, 
when flesh devoid of humors grows up, and 
thus there will be no fungous flesh in the sore. 
The same thing applies to the membrane which 
surrounds the brain: for when, by sawing the 
bone, and removing it from the meninx, you 
lay the latter bare, you must make it clean and 
dry as quickly as possible, lest being in a moist 
state for a considerable time, it become soaked 
therewith and swelled; for when these things 
occur, there is danger of its mortifying. 

1 6. A piece of bone that must separate from 
the rest of the bone, in consequence of a wound 
in the head, either from the indentation (hedra) 
of a blow in the bone, or from the bone being 
otherwise denuded for a long time, separates 
mostly by becoming exsanguous. For the bone 
becomes dried up and loses its blood by time 
and a multiplicity of medicines which are used; 
and the separation will take place most quickly, 
if one having cleaned the wound as quickly as 
possible will next dry it, and the piece of bone, 
whether larger or smaller. For a piece of bone 
which is quickly dried and con verted, as it were, 
into a shell, is most readily separated from the 
rest of the bone which retains its blood and vi- 
tality; for, the part having become exsanguous 
and dry, more readily drops off from that which 
retains its blood and is alive. 

17. Such pieces of bone as are depressed from 
their natural position, either being broken off 
or chopped off to a considerable extent, are at- 
tended with less danger, provided the mem- 
brane be safe; and bones which arc broken by 



On Injuries of the Head 



numerous and broader fractures are still less 
dangerous and more easily extracted. And you 
must not trepan any of them, nor run any risks 
in attempting to extract the pieces of bone, un- 
til they rise up of their own accord, upon the 
subsidence of the swelling. They rise up when 
the flesh (granulations) grows below, and it 
grows from the diploe of the bone, and from 
the sound portion, provided the upper table 
alone be in a state of necrosis. And the flesh will 
shoot up and grow below the more quickly, and 
the pieces of bone ascend, if one will get the 
wound to suppurate and make it clean as quick- 
ly as possible. And when both the tables of the 
bone are driven in upon the membrane, I mean 
the upper and lower, the wound, if treated in 
the same way, will very soon get well, and the 
depressed bones will quickly rise up. 

1 8. The bones of children are thinner and 
softer, for this reason, that they contain more 
blood [than those of adults] ; and they are por- 
ous and spongy, and neither dense nor hard. 
And when wounded to a similar or inferior de- 
gree by weapons of the same or even of an in- 
ferior power, the bone of a young person more 
readily and quickly suppurates, and that in less 
time than the bone of an older person; and in 
accidents, which are to prove fatal, the younger 
person will die sooner than the elder. But if the 
bone is laid bare of flesh, one must attend and 
try to find out, what even is not obvious to the 
sight, and discover whether the bone be broken 
and contused, or only contused; and if, when 
there is an indentation in the bone, whether 
contusion, or fracture, or both be joined to it; 
and if the bone has sustained any of these in- 
juries, we must give issue to the blood by per- 
forating the bone with a small trepan, observing 
the greatest precautions, for the bone of young 
persons is thinner and more superficial than that 
of elder persons. 

19. When a person has sustained a mortal 
wound on the head, which cannot be cured, nor 
his life preserved, you may form an opinion of 
his approaching dissolution, and foretell what 
is to happen from the following symptoms 
which such a person experiences. When a bone 
is broken, or cleft, or contused, or otherwise in- 
jured, and when by mistake it has not been dis- 
covered, and neither the raspatory nor trepan 
has been applied as required, but the case has 
been neglected as if the bone were sound, fever 
will generally come on before the fourteenth day 
if in winter, and in summer the fever usually 
seizes after seven days. And when this happens, 
the wound loses its color, and the inflammation 



dies in it; and it becomes glutinous, and appears 
like a pickle, being of a tawny and somewhat 
livid color; and the bone then begins to sphace- 
late, and turns black where it was white before, 
and at last becomes pale and blanched. But 
when suppuration is fairly established in it, 
small blisters form on the tongue and he dies 
delirious. And, for the most part, convulsions 
seize the other side of the body; for, if the wound 
be situated on the left side, the convulsions will 
seize the right side of the body; or if the wound 
be on the right side of the head, the convulsion 
attacks the left side of the body. And some be- 
come apoplectic. And thus they die before the 
end of seven days, if in summer; and before 
fourteen, if in winter. And these symptoms in- 
dicate, in the same manner, whether the wound 
be older or more recent. But if you perceive that 
fever is coming on, and that any of these symp- 
toms accompany it, you must not put off, but 
having sawed the bone to the membrane (men- 
inx), or scraped it with a raspatory (and it is 
then easily sawed or scraped), you must apply 
the other treatment as may seem proper, atten- 
tion being paid to circumstances. 

20. When in any wound of the head, whether 
the man has been trepanned or not, but the 
bone has been laid bare, a red and erysipelatous 
swelling supervenes in the face, and in both 
eyes, or in either of them, and if the swelling be 
painful to the touch, and if fever and rigor 
come on, and if the wound look well, whether 
as regards the flesh or the bone, and if the parts 
surrounding the wound be well, except the 
swelling in the face, and if the swelling be not 
connected with any error in the regimen, you 
must purge the bowels in such a case with a 
medicine which will evacuate bile; and when 
thus purged the fever goes off, the swelling sub- 
sides, and the patient gets well. In giving the 
medicine you must pay attention to the strength 
of the patient. 

21. With regard to trepanning, when there 
is a necessity for it, the following particulars 
should be known. If you have had the manage- 
ment of the case from the first, you must not at 
once saw the bone down to the meninx; for it 
is not proper that the membrane should be laid 
bare and exposed to injuries for a length of time, 
as in the end it may become fungous. And there 
is another danger if you saw the bone down to 
the meninx and remove it at once, lest in the act 
of sawing you should wound the meninx. But 
in trepanning, when only a very little of the 
bone remains to be sawed through, and the 
bone can be moved, you must desist from saw- 



jo Hippocrates 

ing, and leave the bone to fall out of itself. For 
to a bone not sawed through, and where a por- 
tion is left of the sawing, no mischief can hap- 
pen; for the portion now left is sufficiently thin. 
In other respects you must conduct the treat- 
ment as may appear suitable to the wound. 
And in trepanning you must frequently remove 
the trepan, on account of the heat in the bone, 
and plunge it in cold water. For the trepan be- 
ing heated by running round, and heating and 
drying the bone, burns it and makes a larger 
piece of bone around the sawing to drop off, 
than would otherwise do. And if you wish to 
saw at once down to the membrane, and then 
remove the bone, you must also, in like manner, 
frequently take out the trepan and dip it in cold 
water. But if you have not charge of the treat- 
ment from the first, but undertake it from an- 
other after a time, you must saw the bone at once 
down to the meninx with a serrated trepan, and 
in doing so must frequently take out the trepan 
and examine with a sound (specillum), and 
otherwise along the tract of the instrument. 
For the bone is much sooner sawn through, pro- 



vided there be matter below it and in it, and it 
often happens that the bone is more superficial, 
especially if the wound is situated in that part 
of the head where the bone is rather thinner 
than in other parts. But you must take care 
where you apply the trepan, and see that you 
do so only where it appears to be particularly 
thick, and having fixed the instrument there, 
that you frequently make examinations and en- 
deavor by moving the bone to bring it up. Hav- 
ing removed it, you must apply the other suit- 
able remedies to the wound. And if, when you 
have the management of the treatment from 
the first, you wish to saw through the bone at 
once, and remove it from the membrane, you 
must, in like manner, examine the tract of the 
instrument frequently with the sound, and see 
that it is fixed on the thickest part of the bone, 
and endeavor to remove the bone by moving it 
about. But if you use a perforator (trepan?}, 
you must not penetrate to the membrane, if you 
operate on a case which you have had the charge 
of from the first, but must leave a thin scale of 
bone, as described in the process of sawing. 



On the Surgery 



IT IS the business of the physician to know, 
in the first place, things similar and things dis- 
similar; those connected with things most im- 
portant, most easily known, and in anywise 
known; 1 which are to be seen, touched, and 
heard; which are to be perceived in the sight, 
and the touch, and the hearing, and the nose, 
and the tongue, and the understanding; which 
are to be known by all the means we know other 
things. 

2. The things relating to surgery, are the 
patient; the operator; the assistants; the in- 
struments; the light, where and how; how many 
things, and how; where the body, and the in- 
struments; the time; the manner; the place. 

3. The operator is either sitting or standing, 
conveniently for himself, for the person oper- 
ated upon, for the light. There are two kinds of 
light, the common and the artificial; the com- 
mon is not at our disposal, the artificial is at 
our disposal. There are two modes of using 

1 The meaning of the first clause of this sen- 
tence, according to Galen, is, that the first thing 
which the medical practitioner must do is to make 
himself well acquainted with semeiology, by com- 
paring carefully the condition of disease with that 
of health. 



each, either to the light, or from the light (to 
the side?). There is little use of that which is 
from (or oblique to the light), and the degree 
of it is obvious. As to opposite the light, we 
must turn the part to be operated upon to that 
which is most brilliant of present and conven- 
ient lights, unless those parts which should be 
concealed, and which it is a shame to look upon; 
thus the part that is operated upon should be 
opposite the light, and the operator opposite 
the part operated upon, except in so far as he 
does not stand in his own light; for in this case 
the operator will indeed see, but the thing oper- 
ated upon will not be seen. With regard to him- 
self: when sitting, his feet should be raised to 
a direct line with his knees, and nearly in con- 
tact with one another; the knees a little higher 
than the groins, and at some distance from one 
another, for the elbows to rest upon them. The 
robe, in a neat and orderly manner, is to be 
thrown over the elbows and shoulders equally 
and proportionally. With regard to the part 
operated upon; we have to consider how far 
distant, and how near, above, below, on this 
side, on that side, or in the middle. The measure 
as to distance and proximity is, that the elbows 
do not press the knees before, nor the sides be- 



On the Surgery 



hind; that the hands be not raised higher than 
the breasts, nor lower than so as that when the 
breast reposes on the knees he may have the 
hands at right angles with the arm: thus it is 
as regards the medium; but as concerns this 
side or that, the operator must not be beyond 
his seat, but in proportion as he may require 
turning he must shift the body, or part of the 
body, that is operated upon. When standing, he 
must make his inspection, resting firmly and 
equally on both feet; but he must operate while 
supporting himself upon either leg, and not the 
one on the same side with the hand which he 
makes use of; the knee being raised to the 
height of the groins as while sitting; and the 
other measures in like manner. The person oper- 
ated upon should accommodate the operator 
with regard to the other parts of his body, either 
standing, sitting, or lying; so as that he may con- 
tinue to preserve his figure, avoid sinking down, 
shrinking from, turning away; and may main- 
tain the figure and position of the part operated 
upon, during the act of presentation, during 
the operation, and in the subsequent position. 

4. The nails should be neither longer nor 
shorter than the points of the fingers; and the 
surgeon should practice with the extremities 
of the fingers, the index-finger being usually 
turned to the thumb; when using the entire 
hand, it should be prone; when both hands, they 
should be opposed to one another. It greatly 
promotes a dexterous use of the fingers when 
the space between them is large, and when the 
thumb is opposed to the index. But it is clearly 
a disease when the thumb is impaired from 
birth, or when, from a habit contracted during 
the time of nursing, it is impeded in its motions 
by the fingers. One should practice all sorts of 
work with either of them, and with both to- 
gether (for they are both alike), endeavouring 
to do them well, elegantly, quickly, without 
trouble, neatly, and promptly. 

5. The instruments, and when and how they 
should be prepared, will be treated of after- 
wards; so that they may not impede the work, 
and that there may be no difficulty in taking 
hold of them, with the part of the body which 
operates. But if another gives them, he must be 
ready a little beforehand, and do as you direct. 

6. Those about the patient must present the 
part to be operated upon as may seem proper, 
and they must hold the rest of the body steady, 
in silence, and listening to the commands of the 
operator. 

7. There are two views of bandaging: that 
which regards it while doing, and that which 



7* 

regards it when done. It should be done quick- 
ly, without pain, with ease, and with elegance; 
quickly, by despatching the work; without pain, 
by being readily done; with ease, by being pre- 
pared for everything; and with elegance, so that 
it may be agreeable to the sight. By what mode 
of training these accomplishments are to be ac- 
quired has been stated. When done, it should 
fit well and neatly; it is neatly done when with 
judgment, and when it is equal and unequal, 
according as the parts are equal or unequal. 
The forms of it (the bandage? ) are the simple, 
the slightly winding (called ascia), the sloping 
(sima), the monoculus, the rhombus, and the 
semi-rhombus. The form of bandage should be 
suitable to the form and the affection of the part 
to which it is applied. 

8. There are two useful purposes to be ful- 
filled by bandaging: (first,) strength, which is 
imparted by the compression and the number 
of folds. In one case the bandage effects the 
cure, and in another it contributes to the cure. 
For these purposes this is the rule that the 
force of the constriction be such as to prevent 
the adjoining parts from separating, without 
compressing them much, and so that the parts 
may be adjusted but not forced together; and 
that the constriction be small at the extremities, 
and least of all in the middle. The knot and the 
thread that is passed through should not be in 
a downward but in an upward direction, regard 
being had to the circumstances under which 
the case is presented; to position, to the band- 
aging, and to the compression. The commence- 
ment of the ligatures is not to be placed at the 
wound, but where the knot is situated. The 
knot should not be placed where it will be ex- 
posed to friction, nor where it will be in the way, 
nor where it will be useless. The knot and the 
thread should be soft, and not large. 

9. (Second.) One ought to be well aware that 
every bandage has a tendency to fall off towards 
the part that declines or becomes smaller; as, 
for example, upwards, in the case of the head, 
and downwards, in the case of the leg. The 
turns of the bandage should be made from 
right to left, and from left to right, except on 
the head, where it should be in a straight 
direction. When opposite parts are to be band- 
aged together, we must use a bandage with two 
heads; or if we make use of a bandage with one 
head, we must attach it in like manner at some 
fixed point: such, for example, as the middle of 
the head; and so in other cases. Those parts 
which are much exposed to motion, such as the 
joints, where there is a flexion, should have few 



71 Hippocrates 

and slight bandages applied to them, as at the 
ham; but where there is much extension, the 
bandage should be single and broad, as at the 
kneepan; and for the maintenance of the band- 
age in its proper place, some turns should be car- 
ried to those parts which are not much moved, 
and are lank, such as the parts above and be- 
low the knee. In the case of the shoulder, a fold 
should be carried round by the other armpit; in 
that of the groin, by the flanks of the opposite 
side; and of the leg, to above the calf of the leg. 
When the bandage has a tendency to escape 
above, it should be secured below, and vice 
versa; and where there is no means of doing 
this, as in the case of the head, the turns are to 
be made mostly on the most level part of the 
head, and the folds are to be done with as little 
obliquity as possible, so that the firmest part 
being last applied may secure the portions which 
are more movable. When we cannot secure 
the bandaging by means of folds of the cloth, 
nor by suspending them from the opposite side, 
we must have recourse to stitching it with liga- 
tures, either passed circularly or in the form of 
a seam. 

10. The bandages should be clean, light, soft, 
and thin. One should practice rolling with both 
hands together, and with either separately. One 
should also choose a suitable one, according to 
the breadth and thickness of the parts. The 
heads of the bandages should be hard, smooth, 
and neatly put on. That sort of bandaging is 
the worst which quickly falls off; but those are 
bad bandages which neither compress nor yet 
come ofl. 

11. The following are the object which the 
upper bandage, the under bandage, or both aim 
at: The object of the under bandage is either to 
bring together parts that are separated, or to com- 
press such as are expanded, or to separate what 
are contracted, or to restore to shape what are 
distorted, or the contrary. It is necessary to pre- 
pare pieces of linen cloth, which are light, thin, 
soft, clean, having no seams nor protuberances 
on them, but sound, and able to bear some 
stretching, or even a little more than required; 
not dry, but wetted with a juice suitable to the 
purpose required. We must deal with parts 
separated (in a sinus?) in such wise, that the 
parts which are raised may touch the bottom 
without producing pressure; we must begin on 
the sound part, and terminate at the wound; so 
that whatever humor is in it may be expelled, 
and that it may be prevented from collecting 
more. And straight parts are to be bandaged in 
a straight direction, and oblique obliquely, in 



such a position as to create no pain; and so that 
there may be no constriction nor falling off on a 
change of position, either for the purpose of 
taking hold of anything, or laying the limb; and 
that muscles, veins, nerves, and bones may be 
properly placed and adjusted to one another. It 
should be raised or laid in a natural position, 
so as not to occasion pain. In those cases in 
which an abscess is formed, we must act in a 
contrary way. When our object is to bring to- 
gether parts which have become expanded, in 
other respects we must proceed on the same 
plain; and we must commence the bringing to- 
gether from some considerable distance ;and af- 
ter their approach, we must apply compression, 
at first slight, and afterwards stronger, the limit 
of it being the actual contact of the parts. In 
order to separate parts which are drawn togeth- 
er, when attended with inflammation, we must 
proceed on the opposite plan; but when without 
inflammation, we must use the same prepara- 
tions, but bandage in the opposite direction. In 
order to rectify distorted parts, we must pro- 
ceed otherwise on the same principles; but the 
parts which are separated must be brought to- 
gether by an underbandage, by agglutinants, 
and by suspending it (the limb?) in its natural 
position. And when the deformities are the con- 
trary, this is to be done on the contrary plan. 

12. In fractures we must attend to the length, 
breadth, thickness, and number of the com- 
presses. The length should be that of the band- 
aging; the breadth, three or four fingers; thick- 
ness, three or fourfold; number so as to encircle 
the limb, neither more nor less; those applied 
for the purpose of rectifyinga deformity, should 
be of such a length as to encircle it; the breadth 
and thickness being determined by the vacuity, 
which is not to be filled up at once. The upper 
bandages are two, the first of which is to be 
carried from the seat of the injury upwards, 
and the second from the seat of the injury down- 
wards, and from below upwards; the parts 
about the seat of the injury being most com- 
pressed, the extremities least, and the rest in 
proportion. The upper bandages should take in 
a considerable portion of the sound parts. We 
must attend to the number, length, and breadth 
of the bandages; the number must be such as 
not to be inferior to what the injury requires, 
nor occasion compression with the splints, nor 
prove cumbersome, nor occasion any slipping 
of them, nor render them inefficient. As to 
length and breadth, they should be three, four, 
five, or six cubits in length, and as many fingers 
broad. The folds of the strings (selvages?) 



On the Surgery 



should be such as not to occasion pressure; they 
are to be soft and not thick; and all these things 
are to be proportionate to the length, breadth, 
and thickness of the part affected. The splints 
are to be smooth, even, and rounded at the ex- 
tremities; somewhat less all along than the up- 
per bandaging, and thickest at the part to which 
the fracture inclines. Those parts where there 
are tuberosities, and which are devoid of flesh, 
such as the ankles or fingers, we must guard 
from the splints which are placed over them, 
either by position, or by their shortness. They 
are to be secured by the strings in such a man- 
ner as not to occasion pressure at first. A soft, 
consistent, and clean cerate should be rubbed 
into the folds of the bandage. 

13. As to the temperature and quantity of the 
water used, its heat should be just such as the 
hand can bear, and it ought to be known that a 
large quantity is best for producing relaxation 
and attenuation, whereas a moderate quantity is 
best for incarnating and softening. The limit 
to the affusion is, to stop when the parts be- 
come swelled up, and before the swelling sub- 
sides; for the parts swell up at first, and fall 
afterward. 

14. The object on which it (the limb?) is laid 
should be soft, smooth, and sloping upwards to- 
ward the protuberant parts of the body, such as 
the heel or hips, so that there may be no projec- 
tion, nor bending inwards, nor turning aside. 
The canal (spout or gutter?) should rather 
comprehend the whole limb than the half of it, 
attention being paid to the injury and to what- 
ever else appears to create inconvenience. 

15. The presentation of the injured part to 
the physician, the extension, the arrangement, 
and so forth, are to be regulated according to 
nature. What is nature in these operations is to 
be determined by the accomplishment of the 
object which we have in view, and for this pur- 
pose we must look to the part in the state of rest, 
in its middle state, and to habit; in regard to the 
state of rest and relaxation, as in the arm, that 
it be in a line with the hand; and with regard to 
the medium between flexion and extension, that 
the forearm be at right angles to the arm; and 
with regard to habit, it should be considered 
that some limbs bear certain positions prefer- 
ably, as, for example, the thighs extension; for 
in such attitudes the parts can best bear to be 
placed for a considerable time without a change 
of posture. And in the change from the state of 
distention,the muscles, veins, nerves, and bones, 
when properly arranged and secured, will pre- 
serve their relations to one another while the 



73 
limb is raised or placed. 

1 6. The extension should be most powerful 
when the largest and thickest bones, or when 
both are broken; next when the under-bone, 
and least of all, when the upper. When im- 
moderate, it is injurious, except in the case of 
children. The limb should be a little elevated. 
The model by which we judge if the part be 
properly set is the sound part of the same name, 
or the part which is its pair. 

17. Friction can relax, brace, incarnate, at- 
tenuate: hard braces, soft relaxes, much attenu- 
ates, and moderate thickens. 

1 8. The following should be the state of mat- 
ters on the first application of the bandage. The 
person to whom it has been applied should say 
that he feels the compression particularly at 
the seat of the injury, but very little at the ex- 
tremities; the parts should be adjusted but not 
pressed together, and that rather by the number 
of the bandages than by the force of the con- 
striction; and the tightness should rather be on 
the increase during the first day and night; but 
on the next it should be less, and on the third 
the bandages should be loose. On the next day 
a soft swelling should be observed in the ex- 
tremities; and on the third day, when the band- 
aging is loosed, the swelling should be found 
diminished in size, and this should be the case 
every time the bandages are removed. At the 
second application of the bandage, it should be 
ascertained whether the dressing has been prop- 
erly done, and then greater compression should 
be made, and with more bandages; and on the 
third, still greater, and still more. On the seven- 
th day from the first dressing, when the band- 
ages are loosed, the limb should be found slen- 
der and the bones mobile. We must then have 
recourse to the splints, provided the limb be free 
of swelling, pruritus, and ulceration, and allow 
them to remain until twenty days after the acci- 
dent; but if any suspicions arise, the bandages 
must be loosed in the interval. The splints 
should be tightened every third day. 

19. The suspending of a fractured limb in a 
sling, the disposition of it, and the bandaging, all 
have for their object to preserve it in position. 
The principal considerations with regard to the 
position are the habits and the peculiar nature 
of each of the limbs: the varieties are shown in 
running, walking, standing, lying, action, re- 
pose. 

20. It should be kept in mind that exercise 
strengthens, and inactivity wastes. 

21. Compression should be produced by the 
number of bandages, rather than by the force 



74 Hippocrates 

of the constriction. 

22. Incases of ecchymosis, contusions, sprains, 
or swellings not attended with inflammations, 
blood is to be expelled from the wound, in great- 
est quantity to the upper part, and in smallest 
to the inferior; neither the arm nor the leg 
should be placed in a declining position: the 
head of the bandage should be placed on the 
wound, and there the greatest pressure should 
be made; the least at the extremities, and inter- 
mediately in the middle; the last fold of the 
bandage should be at the upper part of the 
body. As to binding and compression, these 
objects are to be attained rather by the number 
of the bandages than the force of the constric- 
tion; and moreover, in these cases the bandages 
should be thin, light, soft, clean, broad, sound, 
so that they may effect their purpose, even with- 
out splints. And we must use affusions. 

23. Dislocations, sprains, diastases of bones, 
violent separation, abruption of the extremities 
of bones, and distrainings, so as to induce v arus 
or valgus, in these cases we must apply the band- 
ages so as not to compress the part whence the 
displacement took place, and that we may ren- 
der them tight at the side to which the displace- 
ment was, and give the limb an inclination in 
the opposite direction, and that in an excessive 
degree. We employ bandages, compresses, sus- 
pension of the limb in a sling, attitude, exten- 
tion, friction, rectification; and along with these 
the affusion of much water. 

24. In treating parts which are atrophied, we 
must comprehend a considerable part of the 
sound limb with the bandage, so that by the in- 
flux thereby produced, the wasted part may ac- 



quire a supply greater than its loss, and may be 
thus disposed to growth and restoration of its 
fleshy parts. It is better also to bandage the parts 
above, as the thigh in the case of the leg, and 
also the thigh and leg of the opposite side, so 
that they may be placed in similar circum- 
stances, and may both equally be deprived of 
motion; and that the supply of nourishment 
may be alike curtailed and open to both. The 
compression should be the effect rather of the 
number of the bandages than of their tight- 
ness. We relax first the part most requiring it, 
and have recourse to that kind of friction which 
will promote the growth of flesh, and to affu- 
sion. No splints. 

25. Those things which are for the purpose of 
giving support and strength to the part, as to 
the breast, side, head, and so forth, are used in 
such cases as the following: for pulsations, that 
there may be no motion in the part; and in sepa- 
ration at the sutures of the skull, in order to give 
support; and in order to strengthen the chest 
and head, in coughs, sneezings, and other move- 
ments. In all these cases the same measure of 
bandaging is to be observed, for where the in- 
jury is, there the bandage should compress 
most, and something soft is to be placed below 
that suits with the complaint; and we must not 
apply the bandages tighter than just to stop the 
pulsations from creating disturbance, and that 
the separated parts at the sutures may be 
brought into contact, they must not be such as 
absolutely to stop the coughs and sneezings, 
but so as to give support, and, without occa- 
sioning uneasiness, prevent the parts from be- 
ing shaken. 



On Fractures 



IN TREATING fractures and dislocations, 
the physician must make the extension as 
straight as possible, for this is the most natural 
direction. But if it incline to either side, it 
should rather turn to that of pronation, f or there 
is thus less harm than if it be toward supina- 
tion. Those, then, who act in such cases without 
deliberation, for the most part do not fall into 
any great mistake, for the person who is to have 
his arm bound, presents it in the proper posi- 
tion from necessity, but physicians who fancy 
themselves learned in these matters, are they 
who commit blunders. There is no necessity for 
much study, then, in order to set a broken arm, 
and in a word, any ordinary physician can per- 



form it; but I am under the necessity of giving 
the longer directions on this subject, because I 
know physicians who have the reputation of 
being skilled in giving the proper positions to 
the arm in binding it up, while in reality they 
are only showing their own ignorance. But 
many other things in our art arc judged of in 
this manner, for people rather admire what is 
new, although they do not know whether it be 
proper or not, than what they are accustomed 
to, and know already to be proper; and what is 
strange, they prefer to what is obvious. I must 
now state what the mistakes of medical men 
are, which I wish to unteach, and what instruc- 
tions I have to give as to the management of the 



On Fractures 



75 



arm; for what I have to say regarding it, will 
apply to the other bones in the body. 

2. The arm, then, for that is the subject we 
were treating of, was presented in the prone 
position to be bound, but the physician forced 
his patient to hold it as the archers do when 
they project the shoulder, and in this position 
he bound it up, thinking within himself that 
he was acting according to Nature, and in proof 
of this he pointed out that all the bones in the 
fore-arm were thus in a straight line, and that 
the integuments both inside and outside, were 
also in a straight line, and that the flesh and 
nerves (tendons?) were thus put in their nat- 
ural position, and he appealed to what hap- 
pens in archery, as a proof of this. And so say- 
ing, and so doing, he is looked up to as a sage; 
and yet he forgets that in all the other arts and 
performances, whether executed by strength or 
dexterity, what is reckoned the natural position 
is not the same, and that in the same piece of 
work it may happen that the natural position of 
the right arm is not the same as that of the left. 
For there is one attitude in throwing the jave- 
lin, and another in slinging, another in casting 
stones, another in boxing, and another in a state 
of repose. And whatever arts one examines, it 
will be found that the natural position of the 
arms is not the same in each, but that in every 
case the arms are put into the attitude which 
suits best with the instrument that is used, and 
the work to be performed. In practicing arch- 
ery, no doubt this is the best attitude of the 
left arm, for the gingly-moid extremity of the 
humerus being fixed in the cavity of the ulna, 
in this position, throws the bones of the fore- 
arm and arm into a line, as if they constituted 
a single bone, and all flexion at the joint is pre- 
vented in this position. It is no doubt certain 
that the member is thus put into the most un- 
^ending and extended position possible, so as 
not to be overcome or yield when the string is 
drawn by the right arm, and thus will the arch- 
er be enabled to draw the string farthest, and 
discharge his arrow with the greatest force and 
rapidity, for arrows thus discharged have the 
greatest swiftness and force, and are carried to 
the greatest distances. But there is nothing in 
common between the binding up of an arm 
and archery. Moreover, if having thus bound 
up the arm, the physician direct the patient to 
keep it thus, he will occasion him greater pain 
than he had from the wound itself; and thus 
also, if the physician order him to bend the arm, 
neither the bones, the nerves, nor the flesh will 
any longer be in the same condition, but will be 



arranged differently, having overcome the band- 
aging. What use, then, is there of the archer's 
attitude? And these mistakes, the physician, 
conceited in his knowledge, would probably not 
have committed if he had allowed the patient 
himself to present his arm. 

3. But another physician putting the arm in- 
to the state of supination, gives orders to extend 
the arm thus, and bandages it in this position, 
reckoning it the one according to nature, judg- 
ing thus from the skin, and also fancying the 
bones to be thus in their natural position, be- 
cause the bone which protrudes at the wrist, 
where the little finger is, appears to be in a line 
with the bone from which people measure the 
bone of the fore-arm. These things he brings 
forward as proofs that the parts are in their 
natural state, and he is supposed to speak cor- 
rectly. But, indeed, if the arm be kept stretched 
in a supine position, it will become very pain- 
ful, and this fact any one may ascertain by ex- 
tending his own arm in this attitude. And al- 
so a weaker man grasping with his hands a 
stronger man whose arm is turned in a supine 
position, could lead him wherever he chose, and 
neither, if a man held a sword thus in his hand, 
could he make any proper use of it, so con- 
strained is this position. And, moreover, if, 
when a physician has thus bound up the arm, 
he allow it to remain in the same position, the 
patient will endure greater pain if he walk 
about, but considerable, even if he remain at 
rest. And thus, too, if he shall bend the arm, the 
muscles and the bones must necessarily assume 
a different position. But, in addition to other 
mischief, he is ignorant of these facts regard- 
ing the position, that the bone which protrudes 
at the wrist, close to the little finger, belongs to 
the fore-arm, whereas the one at the joint, from 
which people measure the fore-arm, is the head 
of the humerus. He fancies that both these be- 
long to the same bone, and many others are of 
this opinion. The latter, in fact, is the same part 
as that which is called the elbow, upon which 
we sometimes rest, and when he holds the arm 
thus in a supine position, in the first place the 
bone appears distorted, and in the next place 
the tendons which extend from the carpus along 
the inner side and from the fingers become dis- 
torted while the arm has a supine position; for 
these tendons proceed to the bone of the hu- 
merus, from which the fore-arm is measured. 
Such, and so many mistakes and marks of igno- 
rance are committed, regarding the natural 
construction of the arm. But if one will extend 
a broken arm as I direct, he will turn the bone, 



Hippocrates 



situated at the extremity of the little finger, in- 
to the straight line, and also the one at the el- 
bow, and the tendons which stretch from the 
carpus to the extremity of the humerus will be 
placed in the straight line; and when the arm 
is suspended in a sling, it will be in the same 
attitude as that in which it was bound up, and 
will give no pain to the patient when he walks 
about, nor when he lies reclined, and will not 
become fatigued. The man should be so seated 
that the prominent part of the bone may be 
turned to the brightest light which is at hand, 
so that the operator in making the extension, 
may be at no loss to discover if it be sufficiently 
straight. The prominence of a broken bone 
could not escape being detected by the hand of 
an experienced person, when applied for this 
purpose, and, moreover, the projecting part is 
particularly painful to the touch. 

4. In cases of fracture in either of the bones 
of the forearm, it is easier to effect a cure if the 
upper bone be broken, although it be the thick- 
er one, both because the sound bone is situated 
below, and forms a support to it, and because 
the deformity is more easily concealed, there 
being a thick mass of flesh on the upper side, 
except near to the wrist. But the lower bone is 
without a covering of flesh, is not easily con- 
cealed, and requires stronger extension. If it is 
not this bone, but the other which is broken, a 
more feeble extension proves sufficient, but if 
both be broken, a more powerful extension is 
required. In the case of a young person I have 
known the extension made more strong than 
was necessary, but in general the extension made 
is less than what is required. And when they are 
extended, the physician should apply the palms 
of the hands, and adjust the fractured parts and 
then having rubbed the parts with cerate, but 
not in large quantity, so that the bandages may 
not come off, it is to be bound up in this state, 
care being taken that the hand be not lower 
than the elbow, but a little higher, so that the 
blood do not flow toward the extremity, but 
may be determined to the upper part; and 
then it is to be secured with the bandage, the 
head of which is to be placed at the fracture, 
and the bandage should impart firmness to the 
parts without occasioning strong compression. 
When you have carried the bandage twice or 
thrice round at the seat of the fracture, it is to 
be carried upward, so that the afflux of blood 
into it may be stopped, and the bandage should 
terminate there, and the first bandages ought 
not to be long. The head of the second band- 
age is also to be placed upon the seat of the frac- 



ture, and a single round of it being made there, 
it is then to be carried downward, and is not to 
be applied so tight as the other, and there should 
be greater distances between the turns, so that 
the bandage may prove sufficient to revert to 
the spot where the other terminated. The band- 
ages may be rolled to the left hand or to the 
right, or to whatever side suits best with the 
position of the fractured arm, or according to 
the inclination which it may have. Afterward 
we must place along the arm, compresses, 
smeared with a little cerate, for thus they occa- 
sion less uneasiness, and are more easily ar- 
ranged. And then we must apply the bandages 
crossways, sometimes to the right hand, and 
sometimes to the left, for the most part begin- 
ning below and terminating above, but some- 
times commencing above and ending below. 
The parts which are thinly covered with flesh 
should be wrapped round with compresses, 
and inequalities should be made up, not by a 
number of folds at once, but by degrees. Some 
slack turns are also to be made around the wrist, 
to this side and to that. These two bandages are 
sufficient at first. 

5. And these are the signs that the patient has 
been well treated and properly bandaged: if 
you ask him if the arm feels tight, and he says 
it does, but moderately so, and especially about 
the fracture; and this reply he should make all 
along, if the bandage be properly applied. And 
these are symptoms of the bandaging being 
moderately tight; if for the first day and night 
he fancies that the tightness does not diminish, 
but rather increases; and if on the next day there 
be a soft swelling in the hand, for this is a sign 
of moderate compression, but at the end of the 
second day the compression should feel less, and 
on the third day the bandaging should appear 
loose. And if any of these symptoms be want- 
ing, you may conclude that the bandaging i$ 
slacker than it should be; or if any of these 
symptoms be in excess, you may infer that the 
compression is more than moderate; and judg- 
ing from these, you will apply the next band- 
ages either slacker or tighter. Having removed 
the bandages on the third day, you must make 
extension and adjust the fracture, and bind it 
up again; and if the first bandaging was moder- 
ately applied, the second bandaging should be 
made somewhat tighter. The heads of the band- 
ages should be placed on the fractures as in the 
former case; for, by so doing, the humors will be 
driven to the extremities, whereas if you band- 
age any other part beforehand, the humors will 
be forced from it to the seat of the fracture: it 



On Fractures 



77 



is of much importance that this should be prop- 
erly understood. Thus the bandaging and com- 
pression should always commence at the seat of 
the fracture, and everything else should be con- 
ducted on the same principle, so that the far- 
ther you proceed from the fracture, the com- 
pression should always be the less. The band- 
ages should never be actually loose, but should 
be smoothly put on. At each dressing the num- 
ber of bandages should be increased; and the pa- 
tient, if asked, should answer, that he feels the 
bandages somewhat tighter than on the former 
occasion, especially about the fracture, and ev- 
erything else in proportion; and with respect 
to the swelling, the pain, and recovery, every- 
thing should proceed as after the former dress- 
ing. But on the third day the outer bandaging 
should appear looser. Then having removed 
the bandages, you should bind it up again, 
somewhat tighter than before, and with all the 
bandages which will be required on the occa- 
sion, and afterwards one ought to experience 
the same train of symptoms as at the former 
periods of bandaging. 

6. When the third day arrives, that is to say, 
the seventh from the first dressing, if properly 
done, the swelling in the hand should be not 
very great; and the part which has been band- 
aged should be found more slender and less 
swelled at each time, and on the seventh day 
the swelling should be quite gone, and the brok- 
en bones should be more readily moved, and 
admit of being easily adjusted. And if these 
things be so, you should, after setting the frac- 
ture, apply the bandages so as to suit the splints, 
and a little more tight than formerly, unless 
there be more pain from the swelling in the 
hand. When you have applied the bandages, 
you must adjust the splints all around the hmb, 
and secure them with strings so loose as just to 
keep them in their place, without the applica- 
tion of the splints contributing at all to the 
compression of the arm. After this the pain and 
recovery should proceed as in the preceding 
periods of the bandaging. But if, on the third 
day, the patient say that the bandaging is loose, 
you must then fasten the splints, especially at 
the fracture, but also elsewhere, wherever the 
bandaging is rather loose than tight. The splint 
should be thickest where the fracture protrudes, 
but it should not be much more so than else- 
where. Particular attention should be paid to 
the line of the arm corresponding to the thumb, 
so that no splint be laid on it, but upon each side 
of it, nor in the line of the little finger where 
the bone is prominent at the wrist, but on each 



side of it. And if it be found necessary that 
splints should be applied in these directions at the 
seat of the fracture, they should be made short- 
er than the others, so as that they may not reach 
the bones which are prominent at the wrist, for 
otherwise there is danger of ulceration, and of 
the tendons being laid bare. The splints should 
be adjusted anew every third day, in a very 
gentle manner, always keeping in mind that 
the object of the splints is to maintain the lower 
bandages in their place, and that they arc not 
needed in order to contribute to the compres- 
sion. 

7. If, then, you see that the bones are prop- 
erly adjusted by the first dressings, and that 
there is no troublesome pruritus in the part, nor 
any reason to suspect ulceration, you may al- 
low the arm to remain bandaged in the splints 
until after the lapse of more than twenty days. 
The bones of the fore-arm generally get con- 
solidated in thirty days altogether; but there is 
nothing precise in this matter, for one constitu- 
tion differs from another, and one period of 
life from another. When you remove the band- 
ages, you must pour hot water on the arm and 
bind it up again, but somewhat slacker, and 
with fewer bandages than formerly: and again 
on the third day you undo the bandages, and 
bind it still more loosely, and with still fewer 
bandages. And if, while the arm is bound up 
in the splints, you should at any time suspect 
that the bones do not lie properly, or if any- 
thing about the bandages annoys the patient, 
you should loose them at the middle of the time, 
or a little earlier, and apply them again. A diet 
slightly restricted will be sufficient in those cases 
in which there was no external wound at first, 
or when the bone does not protrude; but one 
should live rather sparingly until the tenth day, 
as being now deprived of exercise; and tender 
articles of food should be used, such as moder- 
ately loosen the bowels; but one should abstain 
altogether from flesh and wine, and then by de- 
grees resume a more nourishing diet. This doc- 
trine may be laid down as a just rule in the treat- 
ment of fractures, both as to how they should 
be treated, and what will be the results of a prop- 
er plan of treatment; so that one may know, 
that if things do not turn out thus, there has 
been some defect or excess in the treatment. 
And in this simple plan of treatment it is nec- 
essary to attend also to the following directions, 
which some physicians pay little attention to, 
although, when improperly executed, they arc 
capable of marring the whole process of band- 
aging: for if both the bones be broken, or the 



Hippocrates 



lower one only, and the patient who has got his 
arm bandaged keep it slung in a shawl, and 
that the shawl is particularly loose at the frac- 
ture, so that the arm is not properly suspended 
at this end or that, in this case the bone must 
necessarily be found distorted upwards; where- 
as, when both bones are thus broken, if the arm 
recline in the shawl at the wrist and elbow, but 
the rest of it be not kept up, the bone in this 
case will be distorted to the lower side. The 
greater part of the arm and the wrist of the 
hand should therefore be equally suspended in 
a broad soft shawl. 

8. When the arm is broken, if one stretch the 
fore-arm and adjust it while in this position, the 
muscle of the arm will be bound while extend- 
ed; but when the dressing is over, and the pa- 
tient bends his arm at the elbow, the muscle of 
the arm will assume a different shape. The fol- 
lowing, then, is the most natural plan of setting 
the arm: having got a piece of wood a cubit or 
somewhat less in length, like the handles of 
spades, suspend it by means of a chain fastened 
to its extremities at both ends; and having seat- 
ed the man on some high object, the arm is to 
be brought over, so that the armpit may rest on 
the piece of wood, and the man can scarcely 
touch the seat, being almost suspended; then 
having brought another seat, and placed one or 
more leather pillows under the arm, so as to 
keep it a moderate height while it is bent at a 
right angle, the best plan is to put round the 
arm a broad and soft skin, or broad shawl, and 
to hang some great weight to it, so as to pro- 
duce moderate extension; or otherwise, while 
the arm is in the position I have described, a 
strong man is to take hold of it at the elbow and 
pull it downward. But the physician standing 
erect, must perform the proper manipulation, 
having the one foot on some pretty high object, 
and adjusting the bone with the palms of his 
hands; and it will readily be adjusted, for the 
extension is good if properly applied. Then let 
him bind the arm, commencing at the fracture, 
and do otherwise as directed above; let him put 
the same questions and avail himself of the 
same signs to ascertain whether the arm be 
moderately tight or not; and every third day 
let him bind it anew and make it tighter; and 
on the seventh or ninth day let him bind it up 
with splints, and leave it so until after the lapse 
of more than thirty days. And if he suspect that 
the bone is not lying properly, let him remove 
the bandages in the interval, and having ad- 
justed the arm, let him bind it up again. The 
bone of the arm is generally consolidated in 



forty days. When these are past, the dressing is 
to be removed, and fewer and slacker bandages 
applied instead of it. The patient is to be kept 
on a stricter diet, and for a longer space of time 
than in the former case; and we must form our 
judgment of it from the swelling in the hand, 
looking also to the strength of the patient. This 
also should be known, that the arm is naturally 
inclined outward; to this side, therefore, the dis- 
tortion usually takes place, if not properly treat- 
ed; but indeed, all the other bones are usually 
distorted during treatment for fracture to that 
side to which they naturally incline. When, 
therefore, anything of this kind is suspected, 
the arm is to be encircled in a broad shawl, 
which is to be carried round the breast, and 
when the patient goes to rest, a compress of many 
folds, or some such thing, is to be folded and 
placed between the elbow and the side, for thus 
the bending of the bone will be rectified, but 
care must be taken lest it be inclined too much 
inwards. 

9. The human foot is composed of several 
small bones like the hand. These bones there- 
fore are scarcely ever broken, unless the skin at 
the same time be wounded by some sharp and 
heavy body. The treatment of such injuries, 
therefore, will be delivered under the head of 
wounds. But if any bone be moved from its 
place, or a joint of the toes be luxated, or any 
of the bones of the part called the tarsus be dis- 
placed, it must be forced back again to its place 
as described with regard to the hand; and is to 
be treated with cerate, compresses, and band- 
ages, like the fractures, with the exception of 
the splints; and is to be secured tightly in the 
same way, and the bandages renewed on the 
third day; and the patient thus bandaged should 
return the same answers as in fractures, as to 
the bandages feeling tight or slack. All these 
bones recover perfectly in twenty days, except 
those that are connected with the bones of the 
leg, and are in a line with them. It is advantage- 
ous to lie in bed during the whole of this time; 
but the patients, thinking light of the com- 
plaint, have not perseverance to do this, and 
they walk about before they get well; where- 
fore many of these do not make a perfect re- 
covery. And often the pain puts them in mind 
of the injury; and deservedly, for the feet sus- 
tain the weight of the whole body. When, there- 
fore, they walk about before they are whole, the 
joints which have been luxated are cured in- 
completely; and, on that account, while walk- 
ing about, they have pains in the leg from time 
to time. 



On Fractures 



79 



10. But those bones which are connected with 
the bones of the leg are larger than the others, 
and the cure of them when luxuated is more 
protracted. The mode of treatment then is the 
same; but we must use more bandages and 
more splints, and the bandage is to be carried 
round to this side and to that, and pressure is to 
be made as in the other cases, particularly at the 
seat of the luxation, and the first circles of the 
bandages are to be made there. And at each 
time the bandages are taken off, much hot wa- 
ter is to be used, for in all injuries at joints the 
affusion of hot water in large quantity is to be 
had recourse to. And the same symptoms of 
compression and relaxation should manifest 
themselves in the same times, as in the cases 
formerly treated of, and the subsequent band- 
agings should be conducted in like manner. 
These cases get completely well for the most 
part in forty days, if the patients have resolu- 
tion to keep their bed; but if not, they are sub- 
jected to the complaints formerly described, or 
still worse. 

n. In persons who jumping from any high 
object pitch upon their heel with great force, 
the bones are separated, and the veins pour 
forth their contents, owing to the contusion of 
the flesh surrounding the bone, and hence a 
swelling and much pain supervene. For this 
bone (os calcis) is not a small one, protrudes be- 
yond the line of the leg, and is connected with 
important veins and tendons; for the back ten- 
don of the leg is inserted into this bone. Such 
cases are to be treated with cerate, and with 
compresses and bandages; and hot water is to 
be used in large quantity; and they require 
many bandages, which ought to be particularly 
good and appropriate. And if the patient hap- 
pen to have a tender skin about the heel, noth- 
ing is to be done to it; but if, as some have it, 
the skin be thick and hardened, it is to be pared 
down smoothly and thinned, but without 
wounding it. It is not everybody who can apply 
the bandage properly in such cases; for if one 
shall bind the parts, as in other accidents about 
the ankle, sometimes bringing a fold round the 
foot and sometimes round the tendon, these 
turns leave out the heel, which is the seat of the 
contusion, and thus there is danger that the os 
calcis may sphacelate; and if this should take 
place, the impediment may endure for life and 
also in all the other cases of sphacelus, not pro- 
ceeding from such a cause as this; as when, 
from being carelessly allowed to lie in a certain 
position during confinement to bed, the heel 
becomes black, or when a serious wound has 



occurred in the leg and it is long of healing, and 
is connected with the heel, or when the same 
thing happens in the thigh, or when in any dis- 
ease a protracted decubitus takes place on the 
back, in all such cases the sores are inveterate, 
troublesome, and frequently break out again, 
unless particular attention be paid to the cure, 
along with much rest, as in all the cases attend- 
ed with sphacelus. And cases of sphacelus con- 
nected with this cause, in addition to other in- 
conveniences, are attended with great danger 
to the whole body. For they are apt to be at- 
tended with very acute fevers, of the continual 
type, accompanied with tremblings, hiccup, ab- 
erration of intellect, and which prove fatal with- 
in a few days: and there may be lividities of 
bloody veins, 1 with nausea, and gangrene from 
pressure; these diseases may occur, besides the 
sphacelus. Those which have been described 
are the most violent contusion; but in general 
the contusions are mild, and no great care is 
required with regard to the treatment, and yet 
it must be conducted properly. But when the 
contusion appears to be severe, we must do as 
described above, making many turns of the 
bandage around the heel, sometimes carrying it 
to the extremity of the foot, sometimes to the 
middle, and sometimes around the leg; and, in 
addition, all the surrounding parts are to be 
bandaged in this direction and that, as former- 
ly described; and the compression should not be 
made strong, but we should make use of many 
bandages, and it is better also to administer hel- 
lebore the same day or on the morrow; and the 
bandages should be removed on the third day 
and reapplied. And these are the symptoms by 
which we discover whether the case will get 
worse or not: when the extra vasated blood, the 
lividities, and the surrounding parts become 
red and hard, there is danger of an exacerba- 
tion. But if there be no fever, we must give 
emetics, as has been said, and administer the 
other remedies which are applicable when the 
fever is not of a continual type; but if continual 
fever be present, we must not give strong medi- 
cines, but enjoin abstinence from solid food and 
soups, and give water for drink, and not allow 
wine but oxyglyty (a composition from vine- 
gar and honey?). But if the case be not going 
to get worse, the ecchymosed and livid parts, 
and those surrounding them become greenish 
and not hard; for this is a satisfactory proof 
in all cases of ecchymosis, that they are not to 
get worse; but when lividity is complicated 

1 By bloody veins is meant veins of a large size, 
as Galen explains. 



8o Hippocrates 

with hardness, there is danger that the part 
may become blackened. And we must so man- 
age the foot as that it may be generally raised a 
little higher than the rest of the body. Such a 
patient will get well in sixty days if he keep 
quiet. 

12. The leg consists of two bones, of which 
the one is much more slender than the other at 
one part, but not much more slender at an- 
other. These are connected together at the foot, 
and form a common epiphysis, but they are not 
united together along the line of the leg; and 
at the thigh they are united together and form 
an epiphysis, and this epiphysis has a diaphysis; 
but the other bone in a line with the little toe is 
a little longer. Such is the nature of the bones of 
the leg. 

13. Sometimes the bones connected with the 
foot are displaced, sometimes both bones with 
their epiphysis; sometimes the whole epiphysis 
is slightly moved, and sometimes the other bone. 
These cases are less troublesome than the same 
accidents at the wrist, if the patients will have 
resolution to give them rest. The mode of treat- 
ment is the same as that of the other, for the re- 
duction is to be made, as of the other, by means 
of extension, but greater force is required, as 
the parts of the body concerned are stronger in 
this case. But, for the most part, two men will 
be sufficient, by making extension in opposite 
directions, but, if they are not sufficiently strong, 
it is easy to make more powerful extension in 
the following way: having fixed in the ground 
either the nave of a wheel, or any such object, 
something soft is to be bound round the foot, 
and then some broad thongs of ox-skin being 
brought round it, the heads of the thongs are 
to be fastened to a pestle or any other piece of 
wood, the end of which is to be inserted into 
the nave, and it, the pestle, is to be pulled away, 
while other persons make counter-extension by 
grasping the shoulders and the ham. It is also 
sometimes necessary to secure the upper ex- 
tremity otherwise; this if you desire to effect, 
fasten deeply in the ground a round, smooth 
piece of wood, and place the upper extremity 
of the piece of wood at the perineum, so that it 
may prevent the body from yielding to the pull- 
ing at the foot, and, moreover, to prevent the 
leg while stretched, from inclining downward; 
some person seated at his side should push back 
the hip, so that the body may not turn round 
with the pulling, and for this purpose, if you 
think fit, pieces of wood may be fastened about 
the armpits on each side, and they are to be 
stretched by the hands, and thus secured, while 



another person takes hold of the limb at the 
knee, and aids in thus making counter-exten- 
sion. Or thus, if you prefer it: having bound 
other thongs of leather about the limb, either at 
the knee, or around the thigh, and having fas- 
tened another nave of a wheel in the ground 
above the head, and adjusted the thongs to some 
piece of wood adapted to the nave, extension 
may thus be made in the opposite direction to 
the feet. Or if you choose, it may be done thus: 
instead of the naves, lay a moderate-sized beam 
under the couch, and then having fastened 
pieces of wood in this beam, both before and 
behind the head, make counter-extension by 
means of thongs, or place windlasses at this ex- 
tremity and that, and make extension by means 
of them. There are many other methods of 
making extension. But the best thing is, for any 
physician who practices in a large city, to have 
prepared a proper wooden machine, with all 
the mechanical powers applicable in cases of 
fractures and dislocation, either for making ex- 
tension, or acting as a lever. For this purpose it 
will be sufficient to possess a board in length, 
breadth, and thickness, resembling the quad- 
rangular threshing-boards made of oak. 

14. When you have made proper extension, it 
is easy to reduce the joint, for the displaced bone 
is thus raised into a line with the other. And 
the bones are to be adjusted with the palms of 
the hands, pressing upon the projecting bone 
with the one, and making counter-pressure be- 
low the ankle with the other. When you have 
replaced the bones, you must apply the band- 
ages while the parts are upon the stretch, if you 
possibly can; but if prevented by the thongs, 
you must loose them, and make counter-exten- 
sion until you get the bandages applied. The 
bandage is to be applied in the manner for- 
merly described, the heads of the bandages being 
placed on the projecting part, and the first turns 
made in like maSher, and so also with regard 
to the number of compresses and the compres- 
sion; and turns of the bandages are to be 
brought frequently round on this and on that 
side of the ankle. But this joint must be bound 
more tight at the first dressing than in the case 
of the hand. But when you have applied the 
bandage, you must place the bandaged part 
somewhat higher than the rest of the body, and 
in such a position that the foot may hang as 
little as possible. The attenuation of the body 
is to be made proportionate to the magnitude 
of the luxation, for one luxation is to be a small, 
and another to a great extent. But in general 
we must reduce more, and for a longer time, 



On Fractures 



81 



in injuries about the legs, than in those about 
the hands; for the former parts are larger and 
thicker than the latter, and it is necessary that 
the body should be kept in a state of rest, and 
in a recumbent position. There is nothing to 
prevent or require the limb to be bandaged a- 
new on the third day. And all the treatment 
otherwise is to be conducted in like manner, as 
in the preceding cases. And if the patient have 
resolution to lie quiet, forty days will be suffici- 
ent for this purpose, if only the bones be prop- 
erly reduced, but if he will not lie quiet, he will 
not be able to use the limb with ease, and he 
will find it necessary to wear a bandage for a 
long time. When the bones are not properly re- 
placed, but there has been some defect in this 
respect, the hip, the thigh, and the leg become 
wasted, and if the dislocation be inward, the 
external part of the thigh is wasted, and vice 
versa. But for the most part the dislocation is 
inward. 

15. And when both bones of the leg are brok- 
en without a wound of the skin, stronger ex- 
tension is required. We may make extension 
by some of the methods formerly described, pro- 
vided the bones ride over one another to a con- 
siderable degree. But extension by men is also 
sufficient, and for the most part two strong men 
will suffice, by making extension and counter- 
extension. Extension must naturally be made 
straight in a line with the leg and thigh, wheth- 
er on account of a fracture of the bones of the 
leg or of the thigh. And in both cases they are 
to be bandaged while in a state of extension, for 
the same position does not suit with the leg and 
the arm. For when the fractured bones of the 
arm or fore-arm are bandaged, the fore-arm is 
suspended in a sling, and if you bind them up 
while extended, the figures of the fleshy parts 
will be changed in bending the arm at the el- 
bow, for the elbow cannot be kept long extend- 
ed, since persons are not in fhe custom of keep- 
ing the joint long in this form, but in a bent 
position, and persons who have been wounded 
in the arm, and are still able to walk about, re- 
quire to have the arm bent at the elbow-joint. 
But the leg, both in walking and standing, is 
habitually extended, either completely or near- 
ly so, and is usually in a depending position 
from its construction, and in order that it may 
bear the weight of the rest of the body. Where- 
fore it readily bears to be extended when neces- 
sary, and even when in bed the limb is often in 
this position . And when wounded, necessity sub- 
dues the understanding, since the patients be- 
come incapable of raising themselves up, so that 



they neither think of bending the limb nor of 
getting up erect, but remain lying in the same 
position. For these reasons, neither the same 
position nor the same mode of bandaging ap- 
plies to the arm and to the leg. If, then, exten- 
sion by means of men be sufficient, we should 
not have recourse to any useless contrivances, 
for it is absurd to employ mechanical means 
when not required; but if extension by men be 
not sufficient, you may use any of the mechan- 
ical powers which is suitable. When sufficiently 
extended, it will be easy to adjust the bones and 
bring them into their natural position, by 
straightening and arranging them with the 
palms of the hand. 

1 6. When the parts are adjusted, you should 
apply the bandages while the limb is in a 
stretched position, making the first turns to the 
right or to the left, as may be most suitable; 
and the end of the bandage should be placed 
over the fracture, and the first turns made at 
that place; and then the bandage should be 
carried up the leg, as described with regard to 
the other fractures. But the bandages should be 
broader and longer, and more numerous, in the 
case of the leg than in that of the arm. And 
when it is bandaged it should be laid upon 
some smooth and soft object, so that it may not 
be distorted to the one side or the other, and 
that there may be no protrusion of the bones 
either forward or backward; for this purpose 
nothing is more convenient than a cushion, or 
something similar, either of linen or wool, and 
not hard; it is to be made hollow along its mid- 
dle, and placed below the limb. With regard to 
the canals (gutters?) usually placed below frac- 
tured legs, I am at a loss whether to advise that 
they should be used or not. For they certainly 
are beneficial, but not to the extent which those 
who use them suppose. For the canals do not 
preserve the leg at rest as they suppose; nor, 
when the rest of the body is turned to the one 
side or the other, does the canal prevent the leg 
from following, unless the patient himself pay 
attention; neither does the canal prevent the 
limb from being moved without the body to 
the one side or the other. And a board is an un- 
comfortable thing to have the limb laid upon, 
unless something soft be placed above it. But it 
is a very useful thing in making any subsequent 
arrangements of the bed and in going to stool. 
A limb then may be well or ill arranged with or 
without the canal. But the common people have 
more confidence, and the surgeon is more like- 
ly to escape blame, when the canal is placed un- 
der the limb, although it is not secundum ar- 



8i Hippocrates 

tern. For the limb should by all means lie 
straight upon some level and soft object, since 
the bandaging must necessarily be overcome by 
any distortion in the placing of the leg, when- 
ever or to whatever extent it may be inclined. 
The patient, when bandaged, should return the 
same answers as formerly stated, for the band- 
aging should be the same, and the same swell- 
ings should arise in the extremities, and the 
slackening of the bandages in like manner, and 
the new bandaging on the third day; and the 
bandaged part should be found reduced in 
swelling; and the new bandagings should be 
more tightly put on, and more pieces of cloth 
should be used; and the bandages should be 
carried loosely about the foot, unless the wound 
be near the knee. Extension should be made 
and the bones adjusted at every new bandag- 
ing; for, if properly treated, and if the swelling 
progress in a suitable manner, the bandaged 
limb will have become more slender and atten- 
uated, and the bones will be more mobile, and 
yield more readily to extension. On the seventh, 
the ninth, or the eleventh day, the splints should 
be applied as described in treating of the other 
fractures. Attention should be paid to the posi- 
tion of the splints about the ankles and along 
the tendon of the loot which runs up the leg. 
The bones of the leg get consolidated in forty 
days, if properly treated. But if you suspect that 
anything is wanting to the proper arrangement 
of the limb, or dread any ulceration, you should 
loose the bandages in the interval, and having 
put everything right, apply them again. 

17. But if the other bone (fibula?) of the leg 
be broken, less powerful extension is required, 
and yet it must not be neglected, nor be per- 
formed slovenly, more especially at the first 
bandaging. For in all cases of fracture this ob- 
ject should be attained then as quickly as pos- 
sible. For when the bandage is applied tight 
while the bones are not properly arranged, the 
part becomes more painful. The treatment other- 
wise is the same. 

1 8. Of the bones of the leg, the inner one, 
called the tibia, is the more troublesome to man- 
age, and requires the greater extension; and if 
the broken bones are not properly arranged, it 
is impossible to conceal the distortion, for the 
bone is exposed and wholly uncovered with 
flesh; and it is much longer before patients can 
walk on the leg when this bone is broken. But 
if the outer bone be broken, it causes much 
less trouble, and the deformity, when the bones 
are not properly set, is much more easily con- 
cealed, the bone being well covered with flesh; 



and the patients speedily get on foot, for it is 
the inner bone of the leg which supports the 
most of the weight of the body. For along with 
the thigh, as being in a line with weight thrown 
upon the thigh, the inner bone has more work 
to sustain; inasmuch as it is the head of the 
thigh-bone which sustains the upper part of 
the body, and it is on the inner and not on the 
outer side of the thigh, being in a line with the 
tibia; and the other half of the body approxi- 
mates more to this line than to the external one; 
and at the same time the inner bone is larger 
than the outer, as in the fore-arm the bone in 
the line of the little finger is the slenderer and 
longer. But in the joint of the inferior extrem- 
ity, the disposition of the longer bone is not 
alike, for the elbow and the ham are bent dif- 
ferently. For these reasons when the external 
bone is broken, the patients can soon walk a- 
bout; but in fractures of the inner, it is a long 
time before they can walk. 

19. When the thigh-bone is broken, particu- 
lar pains should be taken with regard to the ex- 
tension that it may not be insufficient, for when 
excessive, no great harm results from it. For, if 
one should bandage a limb while the extremi- 
ties of the bone are separated to a distance from 
one another by the force of the extension, the 
bandaging will not keep them separate, and so 
the bones will come together again as soon as 
the persons stretching it let go their hold; for 
the fleshy parts (muscles?) being thick and 
strong, are more powerful than the bandaging, 
instead of being less so. In the case then which 
we are now treating of, nothing should be omit- 
ted in order that the parts may be properly 
distended and put in a straight line; for it is a 
great disgrace and an injury to exhibit a short- 
ened thigh. For the arm, when shortened, might 
be concealed, and the mistake would not be 
great; but a shortened thigh-bone would exhibit 
the man maimed. For when the sound limb is 
placed beside it, being longer than the other, 
it exposes the mistake, and therefore it would 
be to the advantage of a person who would be 
improperly treated that both his legs should be 
broken, rather than either of them; for in this 
case the one would be of the same length as the 
other. When, then, proper extension has been 
made, you must adjust the parts with the palms 
of the hands, and bandage the limb in the man- 
ner formerly described, placing the hands of 
the bandages as was directed, and making the 
turns upward. And the patient should return 
the same answers to the same questions as for- 
merly, should be pained and recover in like 



On Fractures 



manner, and should have the bandaging re- 
newed in the same way; and the application of 
the splints should be the same. The thigh-bone 
is consolidated in forty days. 

20. But this also should be known, that the 
thigh-bone is curved rather to the outside than 
to the inside, and rather forward than back- 
ward; when not properly treated, then, the dis- 
tortions are in these directions; and the bone is 
least covered with flesh at the same parts, so that 
the distortion cannot be concealed. If, therefore, 
you suspect anything of this kind, you should 
have recourse to the mechanical contrivances 
recommended in distortion of the arm. And a 
few turns of the bandage should be brought 
round by the hip and the loins, so that the groin 
and the articulation near the perineum may be 
included in the bandage; and moreover, it is ex- 
pedient that the extremitiesof the splints should 
not do mischief by being placed on parts not 
covered with the bandages. The splints, in fact, 
should be carefully kept off the naked parts at 
both ends; and the arrangement of them should 
be so managed, as that they may not be placed 
on the natural protuberances of the bone at the 
knee-joint, nor on the tendon which is situated 
there. 

21. The swellings which arise in the ham, at 
the foot, or in any other part from the pressure, 
should be well wrapped in unscoured and card- 
ed wool, washed with wine and oil, and anoint- 
ed with cerate, before bandaging; and if the 
splints give pain they should be slackened. You 
may sooner reduce the swellings, by laying a- 
side the splints, and applying plenty of band- 
ages to them, beginning from below and roll- 
ing upward; for thus the swellings will be most 
speedily reduced, and the humors be propelled 
to the parts above the former bandages. But 
this form of bandaging must not be used unless 
there be danger of vesications or blackening in 
the swelling, and nothing of the kind occurs 
unless the fracture be bound too tight, or unless 
the limb be allowed to hang, or it be rubbed 
with the hand, or some other thing of an irri- 
tant nature be applied to the skin. 

22. More injury than good results from plac- 
ing below the thigh a canal which does not pass 
farther down than the ham, for it neither pre- 
vents the body nor the leg from being moved 
without the thigh. And it creates uneasiness by 
being brought down to the ham, and has a tend- 
ency to produce what of all things should be 
avoided, namely, flexion at the knee, for this 
completely disturbs the bandages; and when the 
thigh and leg are bandaged, if one bend the 



limb at the knee, the muscles necessarily assume 
another shape, and the broken bones are also 
necessarily moved. Every endeavor then should 
be made to keep the ham extended. But it ap- 
pears to me, that a canal which embraces the 
limb from the nates to the foot is of use. And 
moreover, a shawl should be put loosely round 
at the ham, along with the canal, as children 
are swathed in bed; and then, if the thigh-bone 
gets displaced either upward or to the side, it 
can be more easily kept in position by this means 
along with the canal. The canal then should be 
made so as to extend all along the limb or not 
used at all. 

23. The extremity of the heel should be par- 
ticularly attended to, so that it may be properly 
laid, both in fracturesof the legand of the thigh. 
For if the foot be placed in a dependent position, 
while the rest of the body is supported, the limb 
must present a curved appearance at the fore- 
part of the leg; and if the heel be placed higher 
than is proper, and if the rest of the leg be 
rather too low, the bone at the forepart of the 
leg must present a hollow, more especially if the 
heel of the patient be naturally large. But all 
the bones get consolidated more slowly, if not 
laid properly, and if not kept steady in the same 
position, and in this case the callus is more 
feeble. 

24. These things relate to cases in which there 
is fracture of the bones without protrusion of 
the same or wound of any other kind. In those 
cases in which the bones are simply broken 
across, and are not comminuted, but protrude, 
if reduced the same day or next, and secured in 
their place, and if there be no reason to antici- 
pate that any splintered bones will come away; 
and in those in which the broken bones do not 
protrude, nor is the mode of fracture such that 
there is reason to expect the splinters will come 
out, some physicians heal the sores in a way 
which neither does much good nor harm, by 
means of a cleansing application, apply ing pitch 
ointment, or some of the dressings for fresh 
wounds, or anything else which they are accus- 
tomed to do, and binding above them compres- 
ses wetted with wine, or greasy wool, or some- 
thing else of the like nature. And when the 
wounds become clean and are new healed, they 
endeavor to bind up the limb with plenty of 
bandages, and keepit straightwith splints.This 
treatment does some good, and never much 
harm. The bones, however, can never be equal- 
ly well restored to their place, but the part is 
a little more swelled than it should be; and the 
limb will be somewhat shortened, provided 



Hippocrates 



both bones cither of the leg or fore-arm have 
been fractured. 

25. There are others who treat such cases at 
first with bandages, applying them on both 
sides of the scat of the injury, but omit them 
there, and leave the wound uncovered, and after- 
ward they apply to the wound some cleansing 
medicine, and complete the dressing with com- 
presses dipped in wine and greasy wool. This 
plan of treatment is bad, and it is clear that 
those who adopt this mode of practice are guilty 
of great mistakes in other cases of fracture as 
well as these. For it is a most important consid- 
eration to know in what manner the head of the 
bandage should be placed and at what part the 
greatest pressure should be, and what benefits 
would result from applying the end of the band- 
age and the pressure at the proper place, and 
what mischiefs would result from applying the 
head of the bandage and the pressure otherwise 
than at the proper place. Wherefore it has been 
stated in the preceding part of the work what 
are the results of either; and the practice of 
medicine bears witness to the truth of it, for in 
a person thus bandaged, a swelling must neces- 
sarily arise on the wound. For, if even a sound 
piece of skin were bandaged on either side, and 
a part were left in the middle, the part thus left 
unbandaged would become most swelled, and 
would assume a bad color; how then could it 
be that a wound would not suffer in like man- 
ner? The wound then must necessarily become 
discolored and its lips everted, the discharge 
will be ichorousand without pus, and the bones, 
which should not have got into a state of ne- 
crosis, exfoliate; and the wound gets into a 
throbbing and inflamed condition. And they are 
obliged to apply a cataplasm on account of the 
swelling, but this is an unsuitable application to 
parts which are bandaged on both sides, for a use- 
less load is added to the throbbing which for- 
merly existed in it. At last they loose the bandages 
when matters get very serious, and conduct the 
rest of the treatment without bandaging; and 
notwithstanding, if they meet with another case 
of the same description, they treat it in the same 
manner, for they do not think that the applica- 
tion of the bandages on both sides, and the ex- 
posure of the wound are the cause of what hap- 
pened, but some other untoward circumstance. 
Wherefore I would not have written so much 
on this subject, if I had not well known that this 
mode of bandaging is unsuitable, and yet that 
many conduct the treatment in this way, whose 
mistake it is of vital importance to correct, 
while what is here said is a proof, that what 



was formerly written as to the circumstances 
under which bandages should be tightly ap- 
plied to fractures or otherwise has been cor- 
rectly written. 

26. As a general rule it may be said, that in 
those cases in which a separation of bone is not 
expected, the same treatment should be applied 
as when the fractures are not complicated with 
an external wound; for the extension, adjust- 
ment of the bones, and the bandaging, are to be 
conducted in the same manner. To the wound 
itself a cerate mixed with pitch is to be applied, 
a thin folded compress is to be bound upon it, 
and the parts around are to be anointed with 
white cerate. The cloths for bandages and the 
other things should be torn broader than in 
cases in which there is no wound, and the first 
turn of the bandage should be a good deal 
broader than the wound. For a narrower band- 
age than the wound binds the wound like a 
girdle, which is not proper, or the first turn 
should comprehend the whole wound, and the 
bandaging should extend beyond it on both 
sides. The bandage then should be put on in the 
direction of the wound, and should be not quite 
so tight as when there is no wound, but the 
bandage should be otherwise applied in the 
manner described above. The bandages should 
be of a soft consistence, and more especially so 
in such cases than in those not complicated with 
a wound. The number of bandages should not be 
smaller, but rather greater than those former- 
ly described. When applied, the patient should 
have the feeling of the parts being properly se- 
cured, but not too tight, and in particular he 
should be able to say that they are firm about the 
wound. And the intervals of time during which 
the parts seem to be properly adjusted, and those 
in which they get loose, should be the same as 
those formerly described. The bandages should 
be renewed on the third day, and the after treat- 
ment conducted in the same manner as former- 
ly described, except that in the latter case the 
compression should be somewhat less than in 
the former. And if matters go on properly, the 
parts about the wound should be found at every 
dressing always more and more free of swell- 
ing, and the swelling should have subsided on 
the whole part comprehended by the bandages. 
And the suppurations will take place more 
speedily than in the case of wounds treated 
otherwise; and the pieces of flesh in the wound 
which have become black and dead, will sooner 
separate and fall off under this plan of treat- 
ment than any other, and the sore will come more 
quickly to cicatrization when thus treated than 



On Fractures 



otherwise. The reason of all this is, that the parts 
in which the wound is situated, and the sur- 
rounding parts, are kept free of swelling. In all 
other respects the treatment is to be conducted 
as in cases of fracture without a wound of the 
integuments. Splints should not be applied. On 
this account the bandages should be more nu- 
merous than in the former case, both because 
they must be put on less tight, and because the 
splints are later of being applied. But if you do 
apply the splints, they should not be applied 
along the wound, and they are to be put on in a 
loose manner, especial care being taken that 
there may be no great compression from the 
splints. This direction has been formerly given. 
And the diet should be more restricted, and for 
a longer period, in those cases in which there is 
a wound at the commencement, and when the 
bones protrude through the skin; and, in a 
word, the greater the wound, the more severe 
and protracted should the regimen be. 

27. The treatment of the sores is the same in 
those cases of fracture in which there was no 
wound of the skin at first, but one has formed 
in the course of treatment, owing to the pres- 
sure of the splints occasioned by the bandages, 
or from any other cause. In such cases it is as- 
certained that there is an ulcer, by the pain and 
the throbbing; and the swelling in the extremi- 
ties becomes harder than usual, and if you ap- 
ply your finger the redness disappears, but 
speedily returns. If you suspect anything of the 
kind you must loose the dressing, if there be 
any itching below the under-bandages, or in 
any other part that is bandaged, and used a 
pitched cerate instead of the other. If there be 
nothing of that, but if the ulcer be found in an 
irritable state, being very black and foul, and 
the fleshy parts about to suppurate, and the ten- 
dons to slough away, in these cases no part is 
to be exposed to the air, nor is anything to be 
apprehended from these suppurations, but the 
treatment is to be conducted in the same man- 
ner as in those cases in which there was an ex- 
ternal wound at first. You must begin to apply 
the bandages loosely at the swelling in the ex- 
tremities, and then gradually proceed upward 
with the bandaging, so that it may be tight at 
no place, but particularly firm at the sore, and 
less so elsewhere. The first bandages should be 
clean and not narrow, and the number of band- 
ages should be as great as in those cases in which 
the splints were used, or somewhat fewer. To 
the sore itself a compress, anointed with white 
cerate, will be sufficient, for if a piece of flesh 
or nerve (tendon?) become black, it will fall 



off; for such sores are not to be treated with ac- 
rid, but with emollient applications, like burns. 
The bandages are to be renewed every third day, 
and no splints are to be applied, but rest is to be 
more rigidly maintained than in the former 
cases, along with a restricted diet. It should be 
known, that if any piece of flesh or tendon be 
to come away, the mischief will spread much 
less, and the parts will much more speedily drop 
off, and the swelling in the surrounding parts 
will much more completely subside, under this 
treatment, than if any of the cleansing applica- 
tions be put upon the sore. And if any part that 
is to come away shall fall off, the part will in- 
carnate sooner when thus treated than other- 
wise, and will more speedily cicatrize. Such are 
the good effects of knowing how a bandage can 
be well and moderately applied. But a proper 
position, the other parts of the regimen, and 
suitable bandages co-operate. 

28. If you are deceived with regard to a re- 
cent wound, supposing there will be no exfolia- 
tion of the bones, while they are on the eve of 
coming out of the sore, you must not hesitate 
to adopt this mode of treatment; for no great 
mischief will result, provided you have the nec- 
essary dexterity to apply the bandages well and 
without doing any harm. And this is a symp- 
tom of an exfoliation of bone being about to 
take place under this mode of treatment; pus 
runs copiously from the sore, and appears striv- 
ing to make its escape. The bandage must be re- 
newed more frequently on account of the dis- 
charge, since otherwise fevers come on; if the 
sore and surrounding parts be compressed by 
the bandages they become wasted. Cases com- 
plicated with the exfoliation of very small bones, 
do not require any change of treatment, only 
the bandages should be put on more loosely, 
so that the discharge of pus may not be inter- 
cepted, but left free, and the dressings are to be 
frequently renewed until the bone exfoliate, and 
the splints should not be applied until then. 

29. Those cases in which the exfoliation of a 
larger piece of bone is expected, whether you 
discover this at the commencement, or perceive 
subsequently that it is to happen, no longer 
require the same mode of treatment, only that 
the extension and arrangement of the parts are 
to be performed in a manner that has been de- 
scribed; but having formed double compresses, 
not less than half a fathom in breadth (being 
guided in this by the nature of the wound), 
and considerably shorter than what would be 
required to go twice round the part that is 
wounded, but considerably longer than to go 



86 Hippocrates 

once round, and in number what will be suffi- 
cient, these are to be dipped in a black austere 
wine; and beginning at the middle, as is done 
in applying the double-headed bandage, you 
are to wrap the part around and proceed cross- 
ing the heads in the form of the bandage called 
"ascia." These things are to be done at the 
wound, and on both sides of it; and there must 
be no compression, but they are to be laid on 
so as to give support to the wound. And on the 
wound itself is to be applied the pitched cerate, 
or one of the applications to recent wounds, or 
any other medicine which will suit with the 
embrocation. And if it be the summer season, 
the compresses are to be frequently damped 
with wine 4 ; but if the winter season, plenty of 
greasy wool, moistened with wine and oil, 
should be applied. And a goat's skin should be 
spread below, so as to carry off the fluids which 
run from the wound; these must be guarded 
against, and it should be kept in mind, that 
parts which remain long in the same position 
are subject to excoriations which are difficult to 
cure. 

30. In such cases as do not admit of band- 
aging according to any of the methods which 
have been described, or which will be described, 
great pains should be taken that the fractured 
part of the body be laid in a right position, and 
attention should be paid that it may incline up- 
ward rather than downward. But if one would 
wish to do the thing well and dexterously, it is 
proper to have recourse to some mechanical 
contrivance, in order that the fractured part of 
the body may undergo proper and not violent 
extension; and this means is particularly appli- 
cable in fractures of the leg. There are certain 
physicians who, in all fractures of the leg, wheth- 
er bandages be applied or not, fasten the sole of 
the foot to the couch, or to some other piece of 
wood which they have fixed in the ground near 
the couch. These persons thus do all sorts of 
mischief but no good; for it contributes nothing 
to the extension that the foot is thus bound, as 
the rest of the body will no less sink down to the 
foot, and thus the limb will no longer be stretch- 
ed, neither will it do any good toward keeping 
the limb in a proper position, but will do harm, 
for when the rest of the body is turned to this 
side or that, the bandaging will not prevent the 
foot and the bones belonging to it from follow- 
ing the rest of the body. For if it had not been 
bound it would have been less distorted, as it 
would have been the less prevented from fol- 
lowing the motion of the rest of the body. But 
one should sew two balls of Egyptian leather, 



such as are worn by persons confined for a 
length of time in large shackles, and the balls 
should have coats on each side, deeper toward the 
wound, but shorter toward the joints; and the 
balls should be well stuffed and soft, and fit well, 
the one above the ankles, and the other below the 
knee. Sideways it should have below two ap- 
pendages, either of a single or double thong, 
and short, like loops, the one set being placed 
on either side of the ankle, and the other on the 
knee. And the other upper ball should have 
others of the same kind in the same line. Then 
taking four rods, made of the cornel tree, of equal 
length, and of the thickness of a finger, and of 
such length that when bent they will admit of 
being adjusted to the appendages, care should 
be taken that the extremities of the rods bear 
not upon the skin, but on the extremities of the 
balls. There should be three sets of rods, or 
more, one set a little longer than another, and 
another a little shorter and smaller, so that they 
may produce greater or less distention, if re- 
quired. Either of these sets of rods should be 
placed on this side and that of the ankles. If 
these things be properly contrived, they should 
occasion a proper and equable extension in a 
straight line, without giving any pain to the 
wound; for the pressure, if there is any, should 
be thrown at the foot and the thigh. And the 
rods are commodiously arranged on either side 
of the ankles, so as not to interfere with the 
position of the lirnb; and the wound is easily 
examined and easily arranged. And, if thought 
proper, there is nothing to prevent the two up- 
per rods from being fastened to one another; 
and if any light covering be thrown over the 
limb, it will thus be kept off from the wound. 
If, then, the balls be well made, handsome, soft, 
and newly stitched, and if the extension by the 
rods be properly managed, as has been already 
described, this is an excellent contrivance; but 
if any of them do not fit properly, it does more 
harm than good. And all other mechanical con- 
trivances should either be properly done, or not 
be had recourse to at all, for it is a disgraceful and 
awkward thing to use mechancial means in an 
unmechanical way. 

31. Moreover, the greater part of physicians 
treat fractures, both with and without an ex- 
ternal wound, during the first days, by means 
of unwashed wool, and there does not appear 
to be anything improper in this. It is very ex- 
cusable for those who are called upon to treat 
newly-received accidents of this kind, and who 
have no cloth for bandages at hand, to do them 
up with wool; for, except cloth for bandages, 



On Fractures 



one could not have anything better than wool 
in such cases; but a good deal should be used 
for this purpose, and it should be well carded 
and not rough, for in small quantity and of a 
bad quality it has little power. But those who 
approve of binding up the limb with wool for 
a day or two, and on the third and fourth apply 
bandages, and make the greatest compression 
and extension at that period, such persons show 
themselves to be ignorant of the most important 
principles of medicine; for, in a word, at no 
time is it so little proper to disturb all kinds of 
wounds as on the third and fourth day; and all 
sort of probing should be avoided on these days 
in whatever other injuries are attended with 
irritation. For, generally, the third and fourth 
day in most cases of wounds, are those which 
give rise to exacerbations, whether the tendency 
be to inflammation, to a foul condition of the 
sore, or to fevers. And if any piece of informa- 
tion be particularly valuable this is; to which 
of the most important cases in medicine does it 
not apply? and that not only in wounds but in 
many other diseases, unless one should call all 
other diseases wounds. And this doctrine is not 
devoid of a certain degree of plausibility, for 
they are allied to one another in many respects. 
But those who maintain that wool should be 
used until after the first seven days, and then 
that the parts should be extended and adjusted, 
and secured with bandages, would appear not to 
be equally devoid of proper judgment, for the 
most dangerous season for inflammation is then 
past, and the bones being loose can be easily set 
after the lapse of these days. But still this mode 
of treatment is far inferior to that with bandages 
from the commencement; for, the latter method 
exhibits the patient on the seventh day free from 
inflammation, and ready for complete band- 
aging with splints; while the former method 
is far behind in this respect, and is attended with 
many other bad effects which it would be tedi- 
ous to describe. 

310. In those cases of fracture in which the 
bones protrude and cannot be restored to their 
place, the following mode of reduction may be 
practiced: Some small pieces of iron are to be 
prepared like the levers which the cutters of 
stone make use of, one being rather broader 
and another narrower; and there should be 
three of them at least, and still more, so that 
you may use those that suit best; and then, along 
with extension, we must use these as levers, ap- 
plying the under surface of the piece of iron to 
the under fragment of the bone, and the upper 
surface to the upper bone; and, in a word, we 



must operate powerfully with the lever as we 
would do upon a stone or a piece of wood. The 
pieces of iron should be as strong as possible, so 
that they may not bend. This is a powerful 
assistance, provided the pieces of iron be suit- 
able, and one use them properly as levers. Of 
all the mechanical instruments used by men, 
the most powerful are these three, the axis in 
peritrochio, the lever, and the wedge. Without 
these, one or all, men could not perform any of 
their works which require great force. Where- 
fore, reduction with the lever is not to be de- 
spised, for the bones will be reduced in this way, 
or not at all. But if the upper fragment which 
rides over the other does not furnish a suitable 
point of support for the lever, but the protruding 
part is sharp, you must scoop out of the bone 
what will furnish a proper place for the lever 
to rest on. The lever, along with extension, may 
be had recourse to on the day of the accident, or 
next day, but by no means on the third, the 
fourth, and the fifth. For if the limb is dis- 
turbed on these days, and yet the fractured 
bones not reduced, inflammation will be ex- 
cited, and this no less if they are reduced; for 
convulsions are more apt to occur if reduction 
take place, than if the attempt should fail. These 
tacts should be well known, for if convulsions 
should come on when reduction is effected, there 
is little hope of recovery; but it is of use to dis- 
place the bones again if this can be done with 
out trouble. For it is not at the time when the 
parts are in a particularly relaxed condition th-u 
convulsions and tetanus are apt to supervene, 
but when they are more than usually tense. In 
the case we are now treating of, we should not 
disturb the limbon the aforesaid days,but strive 
to keep the wound as free from inflammation 
as possible, and especially encourage suppura- 
tion in it. But when seven days have elapsed, or 
rather more, if there be no fever, and if the 
wound be not inflamed, then there will be less 
to prevent an attempt at reduction, if you hope 
to succeed; but otherwise you need not take and 
give trouble in vain. 

32. When you have reduced the bones to their 
place, the modes of treatment, whether you ex- 
pect the bones to exfoliate or not, have been al- 
ready described. All those cases in which an ex- 
foliation of bone is expected, should be treated 
by the method of bandaging with cloths, begin- 
ning for the most part at the middle of the band- 
age, as is done with the double-headed bandage; 
but particular attention should be paid to the 
shape of the wound, so that its lips may gape or 
be distorted as little as possible under the band- 



88 Hippocrates 

age. Sometimes the turns of the bandage have 
to be made to the right, and sometimes to the 
left, and sometimes a double-headed bandage 
is to be used. 

33. It should be known that bones, which it 
has been found impossible to reduce, as well as 
those which are wholly denuded of flesh, will 
become detached. In some cases the upper part 
of the bone is laid bare, and in others the flesh 
dies all around; and, from a sore of long stand- 
ing, certain of the bones become carious, and 
some not, some more, and some less; and in 
some the small, and in others the large bones. 
From what has been said it will be seen, that it 
is impossible to tell in one word when the bones 
will separate. Some come away more quickly, 
owing to their smallness, and some from being 
merely fixed at the point; and some, from pieces 
not separating, but merely exfoliating, become 
dried up and putrid; and besides, different 
modes of treatment have different effects. For 
the most part, the bones separate most quickly 
in those cases in which suppuration takes place 
most quickly, and when new flesh is most quick- 
ly formed, and is particularly sound, for the 
flesh which grows up below in the wound gen- 
erally elevates the pieces of bone. It will be well 
if the whole circle of the bone separate in forty 
days; for in some cases it is protracted to sixty 
days, and in some to more; for the more porous 
pieces of bone separate more quickly, but the 
more solid come away more slowly; but the 
other smaller splinters in much less time, and 
others otherwise. A portion of bone which pro- 
trudes should be sawn off for the following rea- 
sons: if it cannot be reduced, and if it appears 
that only a small piece is required in order that 
it may get back into its place; and if it be such 
that it can be taken out, and if it occasions in- 
convenience and irritates any part of the flesh, 
and prevents the limb from being properly laid, 
and if, moreover, it be denuded of flesh, such a 
piece of bone should be taken off. With regard 
to the others, it is not of much consequence 
whether they be sawed off or not. For it should 
be known for certain, that such bones as are 
completely deprived of flesh, and have become 
dried, all separate completely. Those which are 
about to exfoliate should not be sawn off. Those 
that will separate completely must be judged of 
from the symptoms that have been laid down. 

34. Such cases are to be treated with compres- 
ses and vinous applications, as formerly laid 
down regarding bones which will separate. We 
must avoid wetting it at the beginning with 
anything cold; for there is danger of febrile rig- 



ors, and also of convulsions; for convulsions 
are induced by cold things, and also sometimes 
by wounds. It is proper to know that the mem- 
bers are necessarily shortened in those cases in 
which the bones have been broken, and have 
healed the one across the other, and in those 
cases in which the whole circle of the bone has 
become detached. 

35. Those cases in which the bone of the 
thigh, or of the arm, protrudes, do not easily re- 
cover. For the bones are large, and contain much 
marrow; and many important nerves, muscles, 
and veins are wounded at the same time. And 
if you reduce them, convulsions usually super- 
vene; and, if not reduced, acute bilious fevers 
come on, with smgultus and mortification. The 
chances of recovery are not fewer in those cases 
in which the parts have not been reduced, nor 
any attempts made at reduction. Still more re- 
cover in those cases in which the lower, than 
those in which the upper part of the bone pro- 
trudes; and some will recover when reduction 
has been made, but very rarely indeed. For 
modes of treatment and peculiarity of consti- 
tution make a great difference as to the capa- 
bility of enduring such an injury. And it makes 
a great difference if the bones of the arm and of 
the thigh protrude to the inside; for there are 
many and important vessels situated there, some 
of which, if wounded, will prove fatal; there are 
such also on the outside, but of less importance. 
In wounds of this sort, then, one ought not to 
be ignorant of the dangers, and should prog- 
nosticate them in due time. But if you are com- 
pelled to have recourse to reduction, and hope 
to succeed, and if the bones do not cross one 
another much, and if the muscles are not con- 
tracted (for they usually are contracted), the 
lever in such cases may be advantageously em- 
ployed. 

36. Having effected the reduction, you must 
give an emollient draught of hellebore the same 
day, provided it has been reduced on the day of 
the accident, but otherwise it should not be at- 
tempted. The wound should be treated with the 
same things as are used in fractures of the bones 
of the head, and nothing cold should be applied; 
the patient should be restricted from food al- 
together, and if naturally of a bilious constitu- 
tion, he should have for a diet a little fragrant 
oxyglyfy sprinkled on water; but if he is not 
bilious, he should have water for drink; and if 
fever of the continual type come on, he is to be 
confined to this regimen for fourteen days at 
least, but if he be free of fever, for only seven 
days, and then you must bring him back by de- 



On Fractures 



8 9 



grecs to a common diet. To those cases in which 
the bones have not been reduced, a similar 
course of medicine should be administered, a- 
long with the same treatment of the sores and 
regimen; and in like manner the suspended part 
of the body should not be stretched, but should 
rather be contracted, so as to relax the parts a- 
bout the wound. The separation of the bones is 
protracted, as also was formerly stated. But one 
should try to escape from such cases, provided 
one can do so honourably, for the hopes of re- 
covery are small, and the dangers many; and if 
the physician do not reduce the fractured bones 
he will be looked upon as unskillful, while by 
reducing them he will bring the patient nearer 
to death than to recovery. 

37. Luxations and subluxations at the knee 
are much milder accidents than subluxations 
and luxations at the elbow. For the knee-joint, 
in proportion to its size, is more compact than 
that of the arm, and has a more even conforma- 
tion, and is rounded, while the joint of the arm 
is large, and has many cavities. And in addition, 
the bones of the leg are nearly of the same 
length, for the external one overtops the other 
to so small an extent as hardly to deserve being 
mentioned, and therefore affords no great re- 
sistance, although the external nerve (liga- 
ment?) at the ham arises from it ; but the bones of 
the fore-arm are unequal, and the shorter iscon- 
siderably thicker than the other, and the more 
slender (ulna?) protrudes, and passes up above 
the joint, and to it (the olecranon?) are attach- 
ed thenerves (ligaments?) which go downward 
to the junction of the bones; and the slender 
bone (ulna?) has more to do with the insertion 
of the ligaments in the arm than the thick bone 
(radius?). The configuration then of the articu- 
lations, and of the bones of the elbow, is such 
as I have described. Owing to their configura- 
tion, the bones at the knee are indeed frequently 
dislocated, but they are easily reduced, for no 
great inflammation follows, nor any constric- 
tion of the joint. They are displaced for the most 
part to the inside, sometimes to the outside, and 
occasionally into the ham. The reduction in all 
these cases is not difficult, but in the dislocations 
inward and outward, the patient should be 
placed on a low seat, and the thigh should 
be elevated, but not much. Moderate exten- 
sion for the most part sufficeth, extension being 
made at the leg, and counter-extension at the 
thigh. 

38. Dislocations at the elbow are more trou- 
blesome than those at the knee, and, owing to 
the inflammation which comes on, and the con- 



figuration of the joint, are more difficult to re- 
duce if the bones are not immediately replaced. 
For the bones at the elbow are less subject to 
dislocation than those of the knee, but are more 
difficult to reduce and keep in their position, 
and are more apt to become inflamed and anky- 
losed. 

39. For the most part the displacements of 
these bones are small, sometimes toward the 
ribs, and sometimes to the outside; and the 
whole articulation is not displaced, but that part 
of the humerus remains in place which is artic- 
ulated with the cavity of the bone of the fore- 
arm that has a protuberance (ulna?). Such dis- 
locations, to whatever side, are easily reduced, 
and the extension is to be made in the line of 
the arm, one person making extension at the 
wrist, and another grasping the armpit, while 
a third, applying the palm of his hand to the 
part of the joint which is displaced, pushes it in- 
ward, and at the same time makes counter- 
pressure on the opposite side near the joint with 
the other hand. 

40. The end of the humerus at the elbow gets 
displaced (subluxated?) by leaving the cavity 
of the ulna. Such luxations readily yield to re- 
duction, if applied before the parts get inflamed. 
The displacement for the most part is to the in- 
side, but sometimes to the outside, and they are 
readily recognized by the shape of the limb. 
And often such luxations are reduced without 
any powerful extension. In dislocations inward, 
the joint is to be pushed into its place, while the 
fore-arm is brought round to a state of prona- 
tion. Such are most of the dislocations at the el- 
bow. 

41. But if the articular extremity of the hu- 
merus be carried to either side above the bone of 
the fore-arm, which is prominent, into the hol- 
low of the arm (?), this rarely happens; but if 
it does happen, extension in the straight line is 
not so proper under such circumstances; for in 
such a mode of extension, the process of the 
ulna (olecranon?) prevents the bone of the arm 
(humerus?) from passing over it. In disloca- 
tions of this kind, extension should be made in 
the manner described when treating of the 
bandaging of fractured bones of the arm, ex- 
tension being made upward at the armpit, 
while the parts at the elbow are pushed down- 
ward, for in this manner can the humerus be 
most readily raised above its cavity; and when 
so raised, the reduction is easy with the palms 
of the hand, the one being applied so as to make 
pressure on the protuberant part of the arm, 
and the other making counter-pressure, so as to 



90 Hippocrates 

push the bone of the fore-arm into the joint. 
This method answers with both cases. And per- 
haps this is the most suitable mode of reduction 
in such a case of dislocation. The parts may be 
reduced by extension in a straight line, but less 
readily than thus. 

42. If the arm be dislocated forward this 
rarely happens, indeed, but what would a sud- 
den shock not displace? for many other things 
are removed from their proper place, notwith- 
standing a great obstacle, in such a violent 
displacement the part (olecranon?) which pass- 
es above the prominent part of the bones is 
large, and the stretching of the nerves (liga- 
ments?) is intense; and yet the parts have been 
so dislocated in certain cases. The following is 
the symptom of such a displacement: the arm 
cannot be bent in the least degree at the elbow, 
and upon feeling the joint the nature of the ac- 
cident becomes obvious. If, then, it is not speed- 
ily reduced, strong and violent inflammation, 
attended with fever, will come on, but if one 
happen to be on the spot at the time it is easily 
reduced. A piece of hard linen cloth (or a piece 
of hard linen, not very large, rolled up in a ball, 
will be sufficient) is to be placed across the bend 
of the elbow, and the arm is then to be sudden- 
ly bent at the elbow, and the hand brought up 
to the shoulder. This mode of reduction is suf- 
ficient in such displacements; and extension in 
the straight line can rectify this manner of dis- 
location, but we must use at the same time the 
palms of the hands, applying the one to the pro- 
jecting part of the humerus at the bend of the 
arm for the purpose of pushing it back, and ap- 
plying the other below to the sharp extremity of 
the elbow, to make counter-pressure, and in- 
cline the parts into the straight line. And one 
may use with advantage in this form of disloca- 
tion the method of extension formerly described, 
for the application of the bandages in the case 
of fracture of the arm; but when extension is 
made, the parts are to be adjusted, as has been 
also described above. 

43. But if the arm be dislocated backward 
(but this very rarely happens, and it is the most 
painful of all, and the most subject to bilious 
fevers of the continual type, which prove fatal 
in the course of a few days), in such a case the 
patient cannot extend the arm. If you are quick- 
ly present, by forcible extension the parts may 
return to their place of their own accord; but if 
fever have previously come on, you must no 
longer attempt reduction, for the pain will be 
rendered more intense by any such violent at- 
tempt. In a word, no joint whatever should be 



reduced during the prevalence of fever, and 
least of all the elbow-joint. 

44. There are also other troublesome injuries 
connected with the elbow-joint; for example, 
the thicker bone (radius?) is sometime par- 
tially displaced from the other, and the patient 
can neither perform extension nor flexion prop- 
erly. This accident becomes obvious upon ex- 
amination with the hand at the bend of the arm 
near the division of the vein that runs up the 
muscle. In such a case it is not easy to reduce 
the parts to their natural state, nor is it easy, in 
the separation of any two bones united by sym- 
physis, to restore them to their natural state, for 
there will necessarily be a swelling at the seat 
of the diastasis. The method of bandaging a 
joint has been already described in treating of 
the application of bandages to the ankle. 

45. In certain cases the process of the ulna 
(olecranon?) behind the humerus is broken; 
sometimes its cartilaginous part, which gives 
origin to the posterior tendon of the arm, and 
sometimes its fore part, at the base of the an- 
terior coronoid process; and when this displace- 
ment takes place, it is apt to be attended with 
malignant fever. The joint, however, remains 
in place, for its whole base protrudes at that 
point. But when the displacement takes place 
where its head overtops the arm, the joint be- 
comes looser if the bone be fairly broken across. 
To speak in general terms, all cases of fractured 
bones are less dangerous than those in which 
the bones are not broken, but the veins and im- 
portant nerves (tendons?) situated in these 
places are contused; for the risk of death is 
more immediate in the latter class of cases than 
in the former, if continual fever come on. But 
fractures of this nature seldom occur. 

46. It sometimes happens that the head of the 
humerus is fractured at its epiphysis; and this, 
although it may appear to be a much more 
troublesome accident, is in fact a much milder 
one than the other injuries at the joint. 

47. The treatment especially befitting each 
particular dislocation has been described; and 
it has been laid down as a rule, that immediate 
reduction is of the utmost advantage, owing to 
the rapid manner in which inflammation of the 
tendons supervenes. For even when the luxated 
parts are immediately reduced, the tendons us- 
ually become stiffened, and for a considerable 
time prevent extension and flexion from being 
performed to the ordinary extent. All these cases 
arc to be treated in a similar way, whether the 
extremity of the articulating bone be snapped 
off, whether the bones be separated, or whether 



On the Articulations 



they be dislocated; for they are all to be treated 
with plenty of bandages, compresses, and ce- 
rate, like other fractures. The position of the 
joint in all these cases should be the same, as 
when a fractured arm or fore-arm has been 
bound up. For this is the most common posi- 
tion in all dislocations, displacements, and frac- 
tures; and it is the most convenient for the sub- 
sequent movements, whether of extension or 
flexion, as being the intermediate stage between 
both. And this is the position in which the pa- 
tient can most conveniently carry or suspend 
his arm in a sling. And besides, if the joint is 
to be stiffened by callus, it were better that this 
should not take place when the arm is extend- 
ed, for this position will be a great impediment 
and little advantage; if the arm be wholly bent, 
it will be more useful; but it will be much more 
convenient to have the joint in the intermediate 
position when it becomes ankylosed. So much 
with regard to position. 

48. In bandaging, the head of the first band- 
age should be placed at the seat of the injury, 
whether it be a case of fracture, of dislocation, 
or of diastasis (separation?), and the first turns 
should be made there, and the bandages should 
be applied most firmly at that place, and less so 
on either side. The bandaging should compre- 
hend both the arm and the fore-arm, and on 
both should be to a much greater extent than 
most physicians apply it, so that the swelling 



may be expelled from the seat of the injury to 
either side. And the point of the fore-arm should 
be comprehended in the bandaging, whether 
the injury be in that place or not, in order that 
the swelling may not collect there. In applying 
bandages, we must avoid as much as possible 
accumulating many turns of the bandage at the 
bend of the arm. For the principal compression 
should be at the seat of the injury, and tne same 
rules are to be observed, and at the same pe- 
riods, with regard to compression and relaxa- 
tion, as formerly described respecting the treat- 
ment of broken bones; and the bandages should 
be renewed every third day; and they should 
appear loose on the third day, as in the other 
case. And splints should be applied at the prop- 
er time (for there is nothing unsuitable in them, 
whether the bones be fractured or not, provided 
there is no fever); they should be particularly 
loose, whether applied to the arm or the fore- 
arm, but they must not be thick. It is necessary 
that they should be of unequal size, and that 
the one should ride over the other, whenever 
from the flexion it is judged proper. And the 
application of the compresses should be regu- 
lated in the same manner as has been stated 
with regard to the splints; and they should be 
put on in a somewhat more bulky form at the 
seat of the injury. The periods are to be esti- 
mated from the inflammation, and from what 
has been written on them above. 



On the Articulations 



I AM acquainted with one form in which the 
shoulder-joint is dislocated, namely, that into 
the armpit; I have never seen it take place up- 
ward nor outward; and yet I do not positively 
affirm whether it might be dislocated in these 
directions or not, although I have something 
which I might say on this subject. But neither 
have I ever seen what I considered to be a dis- 
location forward. Physicians, indeed, fancy that 
dislocation is very apt to occur forward, and 
they are more particularly deceived in those per- 
sons who have the fleshy parts about the joint 
and arm much emaciated; for, in all such cases, 
the head of the arm appears to protrude for- 
ward. And I in one case of this kind having 
said that there was no dislocation, exposed my- 
self to censure from certain physicians and com- 
mon people on that account, for they fancied 
that I alone was ignorant of what everybody 
else was acquainted with, and I could not con- 



vince them but with difficulty, that the matter 
was so. But if one will strip the point of the 
shoulder of the fleshy parts, and where the mus- 
cle (deltoid?) extends, and also lay bare the 
tendon that goes from the armpit and clavicle 
to the breast (pectoral muscle?) ^t head of the 
humerus will appear to protrude strongly for- 
ward, although not dislocated, for the head of 
the humerus naturally inclines forward, butthe 
rest of the bone is turned outward. The hu- 
merus is connected obliquely with the cavity of 
the scapula, when the arm is stretched along 
the sides; but when the whole arm is stretched 
forward, then the head of the humerus is in a 
line with the cavity of the humerus, and no 
longer appears to protrude forward. And with 
regard to the variety we are now treating of, I 
have never seen a case of dislocation forward; 
and yet I do not speak decidedly respecting it, 
whether such a dislocation may take place or 



91 Hippocrates 

not. When, then, a dislocation into the armpit 
takes place, seeing it is of frequent occurrence, 
many persons know how to reduce it, for it is 
an easy thing to teach all the methods by which 
physicians effect the reductions, and the best 
manner of applying them . The strongest of those 
methods should be used when the difficulty of 
reduction is particularly great. The strongest is 
the method to be last described. 

2. Those who are subject to frequent disloca- 
tions at the shoulder-joint, are for the most part 
competent to effect the reduction themselves; 
for, having introduced the knuckles of the oth- 
er hand into the armpit, they force the joint up- 
ward, and bring the elbow toward the breast. 
The physician might reduce it in the same man- 
ner, if having introduced his fingers into the 
armpit on the inside of the dislocated joint, he 
would force it from the ribs, pushing his own 
head against the acromion, in order to make 
counter-pressure, and with his knees applied to 
the patient's elbow pushing the arm to the sides. 
It will be of advantage if the operator has strong 
hands, or the physician may do as directed with 
his head and hands, while another person brings 
the elbow toward the breast. Reduction of the 
shoulder may also be effected by carrying the 
fore-arm backward to the spine, and then with 
the one hand grasping it at the elbow, to bend 
the arm upward, and with the other to support 
it behind at the articulation. This mode of re- 
duction, and the one formerly described, are not 
natural, and yet by rotating the bone of the joint, 
they force it to return. 

3. Those who attempt to perform reduction 
with the heel, operate in a manner which is an 
approach to the natural. The patient must lie 
on the ground upon his back, while the person 
who is to effect the reduction is seated on the 
ground upon the side of the dislocation; then 
the operator, seizing with his hand the affected 
arm, is to pull it, while with his heel in the arm- 
pit he pushes in the contrary direction, the right 
heel being placed in the right armpit, and the 
left heel in the left armpit. But a round bail of 
a suitable size must be placed in the hollow of 
the armpit; the most convenient are very small 
and hard balls, formed from several pieces of 
leather sewed together. For without something 
of the kind the heel cannot reach to the head of 
the humerus, since, when the arm is stretched, 
the armpit becomes hollow, the tendons on both 
sides of the armpit making counter-contraction 
so as to oppose the reduction. But another per- 
son should be seated on the other side of the 
patient to hold the sound shoulder, so that the 



body may not be dragged along when the arm 
of the affected side is pulled; and then, when 
the ball is placed in the armpit, a supple piece 
of thong sufficiently broad is to be placed round 
it, and some person taking hold of its two ends 
is to seat himself above the patient's head to 
made counter-extension, while at the same time 
he pushes with his foot against the bone at the 
top of the shoulder. The ball should be placed 
as much on the inside as possible, upon the ribs, 
and not upon the head of the humerus. 

4. There is another method of reduction per- 
formed by the shoulder of a person standing. 
The person operating in this way, who should 
be taller than the patient, is to take hold of his 
arm and place the sharp point of his own shoul- 
der in the patient's armpit, and push it in so 
that it may lodge there, and having for his ob- 
ject that the patient may be suspended at his 
back by the armpit, he must raise himself high- 
er on this shoulder than the other; and he must 
bring the arm of the suspended patient as quick- 
ly as possible to his own breast. In this position 
he should shake the patient when he raises him 
up, in order that the rest of the body may be a 
counterpoise to the arm which is thus held. But 
if the patient be very light, a light child should 
be suspended behind along with him. These 
methods of reduction are all of easy application 
in the palestra, as they can all be performed with- 
out instruments, but they may also be used else- 
where. 

5. Those who accomplish the reduction by 
forcibly bending it round a pestle, operate in a 
manner which is nearly natural. But the pestle 
should be wrapped in a soft shawl (for thus it 
will be less slippery), and it should be forced 
between the ribs and the head of the humerus. 
And if the pestle be short, the patient should be 
seated upon something, so that his arm can with 
difficulty pass above the pestle. But for the most 
part the pestle should be longer, so that the pa- 
tient when standing may be almost suspended 
upon the piece of wood. And then the arm and 
forearm should be stretched along the pestle, 
whilst some person secures the opposite side of 
the body by throwing his arms round the neck, 
near the clavicle. 

6. But the method with a ladder is another of 
the same kind, and still better, since by it the 
body can be more safely counterpoised on this 
side; and that, while in the method which the 
piece of wood resembling a pestle, there is dan- 
ger of the body tumbling to either side. But 
some round thing should be tied upon the step 
of the ladder which may be fitted to the armpit, 



On the Articulations 



93 



whereby the head of the bone may be forced in- 
to its natural place. 

7. The following, however, is the strongest of 
all the methods of reduction. We must get a 
piece of wood, five, or at least four inches broad, 
two inches in thickness, or still thinner, and two 
cubits in length, or a little less; and its extremity 
at one end should be rounded, and made very 
narrow and very slender there, and it should 
have a slightly projecting edge (ambe) on its 
round extremity, not on the part that is to be 
applied to the side, but to the head of the hu- 
merus, so that it may be adjusted in the armpit 
at the sides under the head of the humerus;and 
a piece of soft shawl or cloth should be glued to 
the end of the piece of wood, so as to give the 
less pain upon pressure. Then having pushed 
the head of this piece of wood as far inward as 
possible between the ribs and the head of the 
humerus, the whole arm is to be stretched along 
this piece of wood, and is to be bound round at 
the arm, the fore-arm, and the wrist, so that it 
may be particularly well secured ; but great pains 
should be taken that the extremity of this piece 
of wood should be introduced as far as possible 
into the armpit, and that it is carried past the 
head of the humerus. Then a cross-beam is to 
be securely fastened between two pillars, and 
afterward the arm with the piece of wood at- 
tached to it is tobebroughtoverthiscross-beam, 
so that the arm may be on the one side of it and 
the body on the other, and the cross-beam in 
the armpit; and then the arm with the piece of 
wood is to be forced down on the one side of the 
cross-beam, and the rest of the body on the other. 
The cross-beam is to be bound so high that the 
rest of the body may be raised upon tip-toes. 
This is by far the most powerful method of ef- 
fecting reduction of the shoulder; for one thus 
operates with the lever upon the most correct 
principles, provided only the piece of wood be 
placed as much as possible within the head of 
the humerus, and thus also the counter-balanc- 
ing weights will be most properly adjusted, and 
safely applied to the bone of the arm. Wherefore 
recent cases in this way may be reduced more 
quickly than could be believed, before even ex- 
tension would appear to be applied; and this is 
the only mode of reduction capable of replac- 
ing old dislocations, and this it will effect, un- 
less flesh has already filled up the (glenoid) 
cavity, and the head of the humerus has formed 
a socket for itself in the place to which it has 
been displaced; and even in such an old case of 
dislocation, it appears to me that we could ef- 
fect reduction (for what object would a lever 



power properly applied not move ? ), but it would 
not remain in its place, but would be again dis- 
placed as formerly. The same thing may be ef- 
fected by means of the ladder, by preparing it 
in the same manner. If the dislocation be re- 
cent, a large Thessalian chair may be sufficient 
to accomplish this purpose; the wood, however, 
should be dressed up as described before; but 
the patient should be seated sideways on the 
chair, and then the arm, with the piece of wood 
attached to it, is to be brought over the back of 
the chair, and force is to be applied to the arm, 
with the wood on the one side, and the body on 
the other side. The same means may be applied 
with a double door. One should always use what 
happens to be at hand. 

8. Wherefore it should be known that one 
constitution differs much from another as to the 
facility with which dislocations in them may 
be reduced, and one articular cavity differs much 
from another, the one being so constructed that 
the bone readily leaps out of it, and another less 
so; but the greatest difference regards the bind- 
ing together of the parts by the nerves (liga- 
ments?) which are slack in some and tight in 
others. For the humidity in the joints of men is 
connected with the state of the ligaments, when 
they are slack and yielding; for you may see 
many people who are so humid (flabby?) that 
when they choose they can disarticulate their 
joints without pain, and reduce them in like 
manner. The habit of the body also occasions a 
certain difference, for in those who are in a state 
of embonpoint and fleshy the joint is rarely dis- 
located, but is more difficult to reduce; but when 
they are more attenuated and leaner than usual, 
then they are more subject to dislocations which 
are more easily reduced. And the following ob- 
servation is a proof that matters are so; for in 
cattle the thighs are most apt to be dislocated at 
the hip-joint, when they are most particularly 
lean, which they are at the end of winter, at 
which time then they are particularly subject 
to dislocations (if I may be allowed to make 
such an observation while treating of a medi- 
cal subject) ; and therefore Homer has well re- 
marked, that of all beasts oxen suffer the most 
at that season, and especially those employed at 
the plow as being worked in the winter season. 
In them, therefore, dislocations happen most 
frequently, as being at that time most particular- 
ly reduced in flesh. And other cattle can crop 
the grass when it is short, but the ox cannot do 
so until it becomes long; for, in the others, the 
projection of the lip is slender, and so is the up- 
per lip, but in the ox the projection of the lip 



94 



Hippocrates 



is thick, and the upper jaw is thick and obtuse, 
and therefore they a re incapable of seizing short 
herbs. But thcsolidungula as having prominent 
teeth in both their front jaws, can crop the grass 
and grasp it with their teeth while short, and de- 
light more in short grass than in rank; for, in 
general, short grass is better and more substan- 
tial than rank, as having not yet given out its 
fructification. Wherefore the poet has the fol- 
lowing line: 

As when to horned cattle dear the vernal season 
comes, 1 

because rank grass appears to be most sought 
after by them. But otherwise in the ox, this joint 
is slacker than in other animals, and, therefore, 
this animal drags his foot in walking more than 
any other, and especially when lank and old. For 
all these reasons the ox is most particularly sub- 
ject to dislocations; and I have made the more 
observations respecting him, as they confirm 
all that was said before on this subject. With 
regard, then, to the matter on hand, I say that 
dislocations occur more readily, and are more 
speedily reduced in those who are lean than in 
those who are fleshy; and in those who are hu- 
mid and lank there is less inflammation than in 
such as are dry and fleshy, and they are less com- 
pactly knit hereafter, and there is more mucos- 
ity than usual in cases not attended with inflam- 
mation, and hence the joints are more liable to 
luxations; for, in the main, the articulations are 
more subject tomucosities in those who are lean 
than in those who are fleshy; and the flesh of 
lean persons who have not been reduced by a 
proper course of discipline abounds more with 
mucosity than that of fat persons. But in those 
cases in which the mucosity is accompanied 
with inflammation, the inflammation binds 
(braces?) the joint, and hence those who have 
small collections of mucosities are not very sub- 
ject to dislocations, which they would be if the 
mucosity had not been accompanied with more 
or less inflammation. 

9. In cases of dislocation those persons who 
are not attacked with inflammation of the sur- 
rounding parts, can use the shoulder immediate- 
ly without pain, and do not think it necessary to 
take any precautions with themselves; it is 
therefore the business of the physician to warn 
them beforehand that dislocation is more likely 
to return in such cases than when the tendons 
have been inflamed. This remark applies to all 
the articulations, but particularly to those of the 

1 There is no such line in the works of Homer as 
they have come down to us. 



shoulder and knee, for these are the joints most 
subject to luxations. But those who have inflam- 
mation of the ligaments cannot use the shoulder, 
for the pain and the tension induced by the in- 
flammation prevent them. Such cases are to be 
treated with cerate, compresses, and plenty of 
bandages; but a ball of soft clean wool is to be 
introduced into the armpit, to fill up the hollow 
of it, that it may be a support to the bandaging, 
and maintain the joint in situ.The arm, in gen- 
eral, should be inclined upward as much as pos- 
sible, for thus it will be kept at the greatest pos- 
sible distance from the place at which the head 
of the humerus escaped. And when you band- 
age the shoulder you must fasten the arms to the 
sides with a band, which is to be carried round 
the body. The shoulder should be rubbed gently 
and softly. The physician ought to be acquaint- 
ed with many things, and among others with 
friction; for from the same name the same re- 
sults are not always obtained; for friction could 
brace a joint when unseasonably relaxed, and 
relax it when unseasonably hard; but we will 
define what we know respecting friction in an- 
other place. The shoulder, then, in such a state, 
should be rubbed with soft hands; and, more- 
over, in a gentle manner, and the joint should 
be moved about, but not roughly, so as to excite 
pain. Things get restored sometimes in a great- 
er space of time, and sometimes in a smaller. 

10. A dislocation may be recognized by the 
following symptoms: Since the parts of a 
man's body are proportionate to one another, as 
the arms and the legs, the sound should always 
be compared with the unsound, and the un- 
sound with the sound, not paying regard to the 
joints of other individuals (for one person's 
joints are more prominent than another's), but 
looking to those of the patient, to ascertain 
whether the sound joint be unlike the unsound. 
This is a proper rule, and yet it may lead to 
much error; and on this account it is not suffi- 
cient to know this art in theory, but also by ac- 
tual practice; for many persons from pain, or 
from any other cause, when their joints are not 
dislocated, cannot put the parts into the same 
positions as the sound body can be put into; one 
ought therefore to know and be acquainted be- 
forehand with such an attitude. But in a dislo- 
cated joint the head of the humerus appears ly- 
ing much more in the armpit than it is in the 
sound joint; and also, above, at the top of the 
shoulder, the part appears hollow, and the acro- 
mion is prominent, owing to the bone of the 
joint having sunk into the part below; there is 
a source of error in this case also, as will be de- 



On the Articulations 



95 



scribed afterward, for it deserves to be described ; 
and also, the elbow of the dislocated arm is far- 
ther removed from the ribs than that of the oth- 
er; but by using force it may be approximated, 
though with considerable pain; and also they 
cannot, with the elbow extended, raise the arm 
to the ear, as they can the sound arm, nor move 
it about as formerly in this direction and that. 
These, then, are the symptoms of dislocation at 
the shoulder. The methods of reduction and 
the treatment are as described. 

1 1 . It deserves to be known how a shoulder 
which is subject to frequent dislocations should 
be treated. For many persons owing to this ac- 
cident have been obliged to abandon gymnastic 
exercises, though otherwise well qualified for 
them; and from the same misfortune have be- 
come inept in warlike practices, and have thus 
perished. And this subject deserves to be noticed, 
because I have never known any physician treat 
the case properly; some abandon the attempt al- 
together, and others hold opinions and prac- 
tice the very reverse of what is proper. For many 
physicians have burned the shoulders subject to 
dislocation, at the top of the shoulder, at the 
anterior part where the head of the humerus 
protrudes, and a little behind the top of the 
shoulder; these burnings, if the dislocation of 
the arm were upward, or forward, or backward, 
would have been properly performed; but now, 
when the dislocation is downward, they rather 
promote than prevent dislocations, for they shut 
out the head of the humerus from the free space 
above. The cautery should be applied thus: tak- 
ing hold with the hands of the skin at the arm- 
pit, it is to be drawn into the line, in which the 
head of the humerus is dislocated; and then the 
skin thus drawn aside is to be burnt to the oppo- 
site side. The burnings should be performed 
with irons, which are not thick nor much round- 
ed, but of an oblong form (for thus they pass 
the more readily through), and they are to be 
pushed forward with the hand; the cauteries 
should be red-hot, that they may pass through 
as quickly as possible; for such as are thick pass 
through slowly, and occasion eschars of a great- 
er breadth than convenient, and there is danger 
that the cicatrices may break into one another; 
which, although nothing very bad, is most un- 
seemly, or awkward. When you have burnt 
through, it will be sufficient, in most cases, to 
make eschars only in the lower part; but if there 
is no danger of the ulcers passing into one an- 
other, and there is a considerable piece of skin 
between them, a thin spatula is to be pushed 
through these holes which have been burned, 



while, at the same time, the skin is stretched, 
for otherwise the instrument could not pass 
through; but when you have passed it through 
you must let go the skin, and then between the 
two eschars you should form another eschar 
with a slender iron, and burn through until you 
come in contact with the spatula. The follow- 
ing directions will enable you todetermine how 
much of the skin of the armpit should be grasp- 
ed; all men have glands in the armpit greater or 
smaller, and also in many other parts of the body. 
But I will treat in another work of the whole 
constitution of the glands, and explain what 
they are, what they signify, and what are their 
offices. The glands, then, are not to be taken 
hold of, nor the parts internal to the glands; for 
this would be attended with great danger, as 
they are adjacent to the most important nerves. 
But the greater part of the substances external 
to the glands are to be grasped, for there is no 
danger from them. And this, also, it is proper to 
know, that if you raise the arm much, you will 
not be able to grasp any quantity of skin worth 
mentioning, for it is all taken up with the 
stretching; and also the nerves, which by all 
means you must avoid wounding, become ex- 
posed and stretched in this position; but if you 
only raise the arm a little, you can grasp a large 
quantity of skin, and the nerves which you 
ought to guard against are left within, and at a 
distance from the operation. Should not, then, 
the utmost pains be taken in the whole practice 
of the art to find out the proper attitude in every 
case? So much regarding the armpit, and these 
contractions will be sufficient, provided the es- 
chars be properly placed. Without the armpit 
there are only two places where one might place 
the eschars to obviate this affection; the one be- 
fore and between the head of the humerus and 
the tendon at the armpit; and then the skin may 
be fairly burned through, but not to any great 
depth, for there is a large vein adjacent, and also 
nerves, neither of which must be touched with 
the heat. But externally, one may form another 
eschar considerably above the tendon at the arm- 
pit, but a little below the head of the humerus; 
and the skin must be burned fairly through, but 
it must not be made very deep, for fire is inimi- 
cal to the nerves. Through the whole treatment 
the sores are to be so treated, as to avoid all strong 
extension of the arm, and this is to be done mod- 
erately, and only as far as the dressing requires; 
for thus they will be less cooled (for it is of im- 
portance to cover up all sorts of burns if one 
would treat them mildly), and then the lips of 
them will be less turned aside; there will be less 



Hippocrates 



hemorrhage and fear of convulsions. But when 
the sores have become clean, and are going on to 
cicatrization, then by all means the arm is to be 
bound to the side night and day ; and even when 
the ulcers are completely healed, the arm must 
still be bound to the side for a long time; for 
thus more especially will cicatrization take place, 
and the wide space into which the humerusused 
to escape will become contracted. 

12. When attempts to reduce a dislocated 
shoulder have failed, if the patient be still grow- 
ing, the bone of the affected arm will not in- 
crease like the sound one, for although it does in- 
crease inso farit becomes shorter than theother; 
and those persons called weasel-armed, become 
so from two accidents, either from having met 
with this dislocation in utero, or from another 
accident, which will be described afterward. 
But those who while they were children have 
had deep-seated suppurations about the head of 
the bone, all become weasel-armed; and this, it 
should be well known, will be the issue, wheth- 
er the abscess be opened by an incision or cau- 
tery, or whether it break spontaneously. Those 
who are thus affected from birth are quite able 
to use the arm, yet neither can they raise the arm 
to the ear, by extending the elbow, but they do 
this much less efficiently than with the sound 
arm. But in those who have had the shoulder 
dislocated after they were grown up, and when 
it has not been reduced, the top of the shoulder 
becomes much less fleshy, and the habit of body 
at that part is attenuated; but when they cease 
to have pain, whatever they attempt to perform 
by raising the elbow from the sides obliquely, 
they can no longer accomplish as formerly; but 
whatever acts are performed by carrying the 
arm around by the sides, either backward or 
forward, all those they can perform; for they can 
work with an auger or a saw, or with a hatchet, 
and can dig, by not raising the elbow too much, 
and do all other kinds of work which are done 
in similar attitudes. 

13. In those cases where the acromion has 
been torn oft, the bone which is thus separated 
appears prominent. The bone is the bond of 
connection between theclavicleand scapula, for 
in this respect the constitution of man is differ- 
ent from that of other animals; physicians are 
particularly liable to be deceived in this accident 
(for as the separated bone protrudes, the top of 
the shoulder appears low and hollow), so that 
they make preparations as if for dislocation of 
the shoulder; for I have known many physi- 
cians, otherwise not inexpert at the art, who 
have done much mischief by attempting to re- 



duce such shoulders, thus supposing it a case 
of dislocation; and they did not desist until they 
gave over hopes of succeeding, or committed 
the mistake of supposing that they had reduced 
the shoulder. The treatment, in these cases, is 
similar to that which is applicable in others of 
a like kind, namely, cerate, compresses, and 
suitable bandaging with linen cloths. The pro- 
jecting part must be pushed down, and the great- 
er number of compresses are to be placed on it, 
and most compression is to be applied at that 
part, and the arm being fastened to the side is 
to be kept elevated; for thus the parts which 
had been torn asunder are brought into closest 
proximity with one another. All this should be 
well known, and if you choose you may prog- 
nosticate safely that no impediment, small or 
great, will result from such an injury at the 
shoulder, only there will be a deformity in the 
place, for the bone cannot be properly restored 
to its natural situation, but there must necessa- 
rily be more or less tumefaction in the upper part. 
For neither can any other bone be made exact- 
ly as it was, which having become incorpo- 
rated with another bone, and having grown to 
it as an apophysis, has been torn from its natu- 
ral situation . If properly bandaged, the acromion 
becomes free of pain in a few days. 

14. When a fractured clavicle is fairly broken 
across it is more easily treated, but when broken 
obliquely it is more difficult to manage. Matters 
are different in these cases from what one would 
have supposed; for a bone fairly broken across 
can be more easily restored to its natural state, 
and with proper care the upper part may be 
brought down by means of suitable position and 
proper bandaging, and even if not properly set, 
the projecting part of the bone is not very sharp. 
But in oblique fractures the case is similar to 
that of bones which have been torn away, as 
formerly described; for they do not admit of 
being restored to their place, and the prominence 
of the bone is very sharp. For the most part, then, 
it should be known, no harm results to the shoul- 
der or to the rest of the body from fracture of 
the clavicle, unless it sphacelate, and this rarely 
happens. A deformity, however, may arise from 
fracture of the clavicle, and in these cases it is 
very great at first, but by and by it becomes less. 
A fractured clavicle, like all other spongy bones, 
gets speedily united; for all such bones form cal- 
lus in a short time. When, then, a fracture has 
recently taken place, the patients attach much 
importance to it, as supposing the mischief 
greater than it really is, and the physicians be- 
stow great pains in order that it may be proper- 



On the Articulations 



97 



ly bandaged; but in a little time the patients, 
having no pain, nor finding any impediment 
to their walking or eating, become negligent; 
and the physicians finding they cannot make 
the parts look well, take themselves off, and are 
not sorry at the neglect of the patients, and in 
the meantime the callus is quickly formed. The 
method of dressing which is most appropriate, 
is similar to that used in ordinary cases, consist- 
ing of cerate, compresses, and bandages; and it 
should be most especially known in this opera- 
tion, that most compresses should be placed on 
the projecting bone, and that the greatest pres- 
sure should be made there. There are certain 
physicians who make a show of superior skill 
by binding a heavy piece of lead on the part in 
order to depress the projecting bone; but this 
mode of treatment does not apply to the clavicle, 
for it is impossible to depress the projecting part 
to any extent worth mentioning. There are oth- 
ers who, knowing the fact that the bandages are 
apt to slip ofl,and that they donot keep the pro- 
jecting parts in their place, apply compresses 
and bandages like the others, and then having 
girt the patient with a girdle, where it is usually 
applied with most effect, they make a heap of 
the compresses upon the projecting bone when 
they apply them, and having fastened the head 
of the bandage to the girdle in front, they ap- 
ply it so as to bring the turns of it into the line 
of the clavicle, carrying them to the back, and 
then bringing them around the girdle they car- 
ry them to the fore part and again backward. 
There are others who do not apply the bandage 
round the girdle, but carry the rounds of it by 
the perineum and anus, and along the spine, so 
as tocompress the fracture. To an inexperienced 
person these methods will appear not far from 
natural, but when tied, they will be found of no 
service; for they do not remain firm any length 
of time, even if the patient keep his bed, al- 
though in this position they answer best; and 
yet even when lying in bed, should he bend his 
leg, or should his trunk be bent, all the bandages 
will be displaced; and, moreover, the bandag- 
ing is inconvenient, inasmuch as the anus is com- 
prehended by it, and many turns of the band- 
age are crowded there in a narrow space. And 
in the method with the girdle, the girdle can- 
not be so firmly girt around, but that the turns 
of the bandage force the girdle to ascend, and 
hence of necessity all the other bandages must 
be slackened. He would seem to me to come 
nearest his purpose, although after all he effects 
but little, who would takea few turns round the 
girdle, but would use the bandage principally 



to secure the former bandaging; for in this man- 
ner the bandages would be most secure, and 
would mutually assist one another. Every thing 
now almost has been said which applies to frac- 
ture of the clavicle. But this also should be 
known, that in fractures of the clavicle, it is the 
part attached to the breast which is uppermost, 
and that the piece attached to the acromion is 
the lowermost. The cause of this is, that for the 
most part the breast can neither be depressed 
nor raised, there being but a slight movement 
of the joint at the breast, for the sternum is con- 
nected together on both sides with the spine. 
The clavicle admits of most motion at the joint 
of the shoulder, and this arises from its connec- 
tion with the acromion. And, moreover, when 
broken, the part which is connected with the ster- 
num flies upward, and is not easily forced down- 
ward; for it is naturally light, and there is more 
room for it above than below. But the shoulder, 
the arm, and the parts connected with them, are 
easily moved from the sides and breast, and, on 
that account, they admit of being considerably 
elevated and depressed. When, therefore, the 
clavicle is broken, the fragment attached to the 
shoulder inclines downward, for it inclines 
much more readily with the shoulder and arm 
downward than upward. Matters being as I 
have stated, they act imprudently who think to 
depress the projecting end of the bone. But it 
is clear that the under part ought to be brought 
to the upper, for the former is the movable part, 
and that which has been displaced from its nat- 
ural position. It is obvious, therefore, that there 
is no other way of applying force to it (for the 
bandages no more force it to than they force it 
from); but if one will push the arm when at the 
sides as much as possible upward, so that the 
shoulder may appear as sharp as possible, it is 
clear that in this way it will be adjusted to the 
fragment of the bone connected with the breast 
from which it was torn. If one then will apply 
a bandage, secundum artem, for the purpose of 
promoting a speedy cure, and will reckon every- 
thing else of no value, except the position as de- 
scribed, he will form a correct opinion of the 
case, and will effect a cure in the speediest and 
most appropriate manner. It is of great impor- 
tance, however, that the patient should lie in a 
recumbent posture. Fourteen days will be suf- 
ficient if he keep quiet, and twenty at most. 

15. But if the clavicle be fractured in the op- 
posite manner (which does not readily happen), 
so that the fragment of boneconnected with the 
breast is depressed, while the piece connected 
with the acromion is raised up and rides over the 



Hippocrates 



other, this case does not require much manage- 
ment, for if the shoulder and arm be let go, the 
fragments of the bone will be adjusted to one 
another, and an ordinary bandage will suffice, 
and the callus will be formed in the course of a 
few days. 

16. If the fracture be not thus, but if it in- 
cline either forward or backward, it may be re- 
stored to its natural position, by raising the 
shoulder with the arm as formerly described, 
and brought back to its natural place, when the 
cure will be speedily accomplished. Most of the 
varieties of displacement may be rectified by 
raising the arm upward. When the upper bone 
is displaced laterally or downward, it would fa- 
vor the adaptation of the parts if the patient 
would lie on his back, and if some elevated sub- 
stance were placed between the shoulder-blades, 
so that the breast may be depressed as much as 
possible upon the two sides; and if, while an- 
other person raised the arm extended along the 
sides, the physician, applying the palm of the 
one hand to the head of the bone, would push it 
away, and with the other would adjust the bro- 
ken bones, he would thus reduce the parts most 
readily to their natural position. But, as former- 
ly stated, the upper bone (sternal fragment?) 
is rarely depressed downward. In most cases, 
after the bandages have been applied, that posi- 
tion is beneficial in which the elbow is fixed to 
the same side, and the shoulder is kept elevated; 
but in certain cases, the shoulder is to be raised, 
as has been directed, and the elbow is to be 
brought forward to the breast, and the hand laid 
on the acromion of the sound side. If the pa- 
tient has the resolution to lie in bed, something 
should be placed so as to support the shoulder, 
and keep it as much elevated as possible. But if 
he walk about, the arm should be slung in a 
shawl, which embraces the point of the elbow, 
and is passed round the neck. 

17. When the elbow-joint is displaced or dis- 
located to the side or outward, while its sharp 
point (olecranon?) remains in the cavity of the 
humerus, extension is to be made in a straight 
line, and the projecting part is to be pushed 
backward and to the side. 

1 8. In complete dislocations toward either 
side, extension is to be made as in bandaging 
fracture of the arm; for thus the rounded part 
of the elbow will not form an obstacle to it. Dis- 
location, for the most part, takes place toward 
the sides (inwardly?). Reduction is to be ef- 
fected by separating (the bones) as much as 
possible, so that the end (of the humerus) may 
not come in contact with the olecranon, and it 



is to be carried up, and turned round, and not 
forced in a straight line, and, at the same time, 
the opposite sides are to be pushed together, and 
propelled into their proper place. It will further 
assist if rotation of the fore-arm be made at the 
elbow, sometimes turning it into a supine posi- 
tion, and sometimes into a prone. The position 
for the treatment consists in keeping the hand a 
little higher than the elbow, and the arm at the 
sides; then it may either be suspended or laid 
at rest, for either position will answer; and na- 
ture and the usage of common means will ac- 
complish the cure, if the callus does not form 
improperly: it is formed quickly. The treat- 
ment is to be conducted with bandages accord- 
ing to the rule for bandaging articulations, and 
the point of the elbow is to be included in the 
bandage. 

19. Dislocations at the elbow give rise to the 
most serious consequences, such as fevers, pain, 
nausea, vomitings of pure bile, and more espe- 
cially when the humerus is displaced backward 
from pressure on the nerve, which occasions 
numbness; next to it is the dislocation forward; 
the treatment is the same; reduction in disloca- 
tion backward is by extension and adaptation; 
the symptom of this variety loss of the power 
of extension; of dislocation forward loss of the 
power of flexion, and in this case reduction is to 
be accomplished by placing a hard ball (in the 
bend of the elbow), and bending the fore-arm 
about it, along with sudden extension. 

20. Diastasis of the bones may be recognized 
by examining the part where the vein that runs 
along the arm divides. 

21. In those cases callus is quickly formed. 
In congenital dislocations the bones below the 
seat of the injury are shorter than natural, and, 
mostly, those nearest to the place; namely, the 
bones of the fore-arm, next those of the hand; 
and, third, those of the fingers. The arm and 
shoulder are stronger, owing to the nourishment 
which they receive, and the other arm, from 
the additional work which it has to perform, is 
still more strong. Wasting of the flesh takes 
place on the inside if the dislocation be on the 
outside; or otherwise, on the side opposite the 
dislocation. 

22. When the elbow is dislocated either in- 
ward or outward, extension is to be made with 
the fore-arm at a right angle to the arm; the 
arm, suspended by means of a shawl passed 
through the armpit, and a weight attached to 
the extremity of the elbow; or force may be ap- 
plied with the hands; when the articular ex- 
tremity has been cleared, the displaced parts are 



On the Articulations 



to be rectified with the palms of the hand, as in 
dislocations of the hands. It is to be bandaged, 
suspended in a sling, and placed while in this 
attitude. 

23. Dislocations backward are to be rectified 
by the palms of the hands, along with sudden ex- 
tension; the two acts are to be performed togeth- 
er, as in other cases of the kind. But in disloca- 
tion forward the arm is to be bent around a ball 
of cloth of proper size, and at the same time re- 
placed. 

24. But if the displacement be on the other 
side, both these operations are to be performed 
in effecting the adjustment. For conducting the 
treatment, the position and bandaging are the 
same as in the other cases. But all these cases 
may be reduced by ordinary distention. 

25. Of the methods of reduction, some oper- 
ate by raising up the part, some by extension, 
and some by rotation: the last consists in rapid- 
ly turning the fore-arm to this side and that. 

26. The joint of the hand is dislocated either 
inward or outward, most frequently inward. 
The symptoms are easily recognized: if inward, 
the patient cannot at all bend his fingers; and if 
outward, he cannot extend them. With regard 
to the reduction, by placing the fingers above 
a table, extension and counter-extension are to 
be made by other persons, while with the palm 
or heel of the hand on the projecting bone one 
pushes forward, and another from behind on 
the other bone; some soft substance is to be ap- 
plied to it, and the arm is to be turned to the 
prone position if the dislocation was forward, 
but to the supine, if backward. The treatment 
is to be conducted with bandages. 

27. The whole hand is dislocated either in- 
ward or outward, or to this side or that, but more 
especially inward; and sometimes the epiphy- 
sis is displaced, and sometimes the other of these 
bones is separated. In these cases strong exten- 
sion is to be applied, and pressure is to be made 
on the projecting bone, and counter-pressure on 
the opposite side, both at the same time, behind 
and at the side, with the hands upon a table, or 
with the heel. These accidents give rise to se- 
rious consequences and deformities; but in the 
course of time the part gets strong, and admits 
of being used. The cure is with bandages, which 
ought to embrace both the hand and fore-arm; 
and splints are to be applied as far as the fingers; 
and when they are used they should be more 
frequently unloosed than in fractures, and more 
copious affusions of water should be used. 

28. In congenital dislocations (at the wrist) 
the hand becomes shortened, and the atrophy 



of the flesh occurs, for the most part, on the side 
opposite to the dislocation. In an adult the bones 
remain of their natural size. 

29. Dislocation at the joint of a finger is eas- 
ily recognized. Reduction is to be effected by 
making extension in a straight line, and apply- 
ing pressure on the projecting bone, and coun- 
ter-pressure on the opposite side of the other. 
The treatment is with bandages. When not re- 
duced, callus is formed outside of the joint. 
When the dislocation takes place at birth, dur- 
ing adolescence the bones below the dislocation 
are shortened, and the flesh is wasted rather on 
the opposite than on the same side with the dis- 
location. When it occurs in an adult the bones 
remain of their proper size. 

30. The jaw-bone, in few cases, is completely 
dislocated, for the zygomatic process formed 
from the upper jaw-bone (malar?) and the bone 
behind the ear (temporal?) shuts up the heads 
of the under jaw, being above the one (candy- 
loid process?), and below the other (coronoid 
process?). Of these extremities of the lower jaw, 
the one, from its length, is not much exposed to 
accidents, while the other, the coronoid, is more 
prominent than the zygoma, and from both 
these heads nervous tendons arise, with which 
the muscles called temporal and masseter are 
connected; they have got these names from their 
actions and connections; for in eating, speak- 
ing, and the other functional uses of the mouth, 
the upper jaw is at rest, as being connected with 
the head by synarthrosis,and not by diarthrosis 
(enarthrosis?): but the lower jaw has motion, 
for it is connected with the upper jaw and the 
head by enarthrosis. Wherefore, in convulsions 
and tetanus, the first symptom manifested is 
rigidity of the lower jaw; and the reason why 
wounds in the temporal region are fatal and in- 
duce coma, will be stated in another place. These 
are the reasons why complete dislocation does 
not readily take place, and this is another rea- 
son, because there is seldom a necessity for swal- 
lowing so large pieces of food as would make a 
man gape more than he easily can, and disloca- 
tion could not take place in any other position 
than in great gaping, by which the jaw is dis- 
placed to either side. This circumstance, how- 
ever, contributes to dislocation there; of nerves 
(ligaments?) and muscles around joints, or con- 
nected with joints, such as are frequently moved 
in using the member are the most yielding to 
extension, in the same manner as well-dressed 
hides yield the most. With regard, then, to the 
matter on hand, the jaw-bone is rarely dislo- 
cated, but is frequently slackened (partially dis- 



ioo Hippocrates 

placed?) in gaping, in the same manner as many 
other derangements of muscles and tendons 
arise. Dislocation is particularly recognized by 
these symptoms: the lower jaw protrudes for- 
ward, there is displacement to the opposite side, 
the coronoid process appears more prominent 
than natural on the upper jaw, and the patient 
cannot shut his lower jaw but with difficulty. 
The mode of reduction which will apply in such 
cases is obvious: one person must secure the pa- 
tient's head, and another, taking hold of the 
lower jaw with his fingers within and without 
at the chin, while the patient gapes as much as 
he can, first moves the lower jaw about for a 
time, pushing it to this side and that with the 
hand, and directing the patient himself to relax 
the jaw, to move it about, and yield as much as 
possible; then all of a sudden the operator must 
open the mouth, while he attends at the same 
time to three positions: for the lower jaw is to 
be moved from the place to which it is dislo- 
cated to its natural position; it is to be pushed 
backward, and along with these the jaws are to 
be brought together and kept shut. This is the 
method of reduction, and it cannot be performed 
in any other way. A short treatment suffices, a 
waxed compress is to be laid on, and bound 
with a loose bandage. It is safer to operate with 
the patient laid on his back, and his head sup- 
ported on a leather cushion well filled, so that 
it may yield as little as possible, but some per- 
son must hold the patient's head. 

31. When the jaw is dislocated on both sides, 
the treatment is the same. The patients are less 
able to shut the mouth than in the former vari- 
ety; and the jaw protrudes farther in this case, 
but is not distorted; the absence of distortion 
may be recognized by comparing the corre- 
sponding rows of the teeth in the upper and 
lower jaws. In such cases reduction should be 
performed as quickly as possible; the method 
of reduction has been described above. If not 
reduced, the patient's life will be in danger from 
continual fevers, coma attended with stupor (for 
these muscles, when disordered and stretched 
preternaturally, induce coma); and there is usu- 
ally diarrhea attended with bilious, unmixed, 
and scanty dejections; and the vomitings, if any, 
consist of pure bile, and the patients common- 
ly die on the tenth day. 

32. In fracture of the lower jaw, when the 
bone is not fairly broken across, and is still par- 
tially retained, but displaced, it should be ad- 
justed by introducing the fingers at the side of 
the tongue, and making suitable counter-pres- 
sure on the outside; and if the teeth at the wound 



be distorted and loosened, when the bone is ad- 
justed, they should be connected together, not 
only two, but more of them, with a gold thread, 
if possible, but otherwise, with a linen thread, 
until the bone be consolidated, and then the 
part is to be dressed with cerate, a few compres- 
ses, and a few bandages, which should not be 
very tight, but rather loose. For it should be 
well known that in fracture of the jaw, dressing 
with bandages, if properly performed, is of little 
advantage, but occasions great mischief if im- 
properly done. Frequent examinations should 
be made about the tongue, and prolonged pres- 
sure should be applied with the fingers, in or- 
der to rectify the displaced bone. It would be 
best if one could do so constantly, but that is 
impossible. 

33. But if the bone be fairly broken across 
(this, however, rarely happens), it is to be set 
in the manner now described. When adjusted, 
the teeth are to be fastened together as former- 
ly described, for this will contribute much to- 
ward keeping the parts at rest, especially if 
properly fastened, and the ends of the thread se- 
cured with knots. But it is not easy to describe 
exactly in writing the whole manipulation of 
the case; but the reader must figure the thing 
to himself from the description given. Then one 
must take a piece of Carthaginian leather; if 
the patient be a younger person, it will be suf- 
ficient to use the outer skin, but if an adult, the 
whole thickness of the hide will be required; it 
is to be cut to the breadth of about three inches, 
or as much as will be required, and having 
smeared the jaw with a little gum (for thus it 
sticks more pleasantly), the end of the skin is 
to be fastened with the glue near the fractured 
part of the jaw, at the distance of an inch or a 
little more, from the wound. This piece is to be 
applied below the jaw; but the thong should 
have a cut in it, in the direction of the chin, so 
that it may go over the sharp point of the chin. 
Another piece of thong like this, or somewhat 
broader, is to be glued to the upper part of the 
jaw, at about the same distance from the wound 
as the other thong; this thong should be so cut 
as to encircle the ear. The thongs should be 
sharp-pointed at the part where they unite, and 
in gluing them, the flesh of the thong should be 
turned to the patient's skin, for in this way it 
will be more tenacious; then we must stretch 
this thong, but still more so the one at the chin, 
in order to prevent the fragments of the jaw 
from riding over each other, and the thongs 
are to be fastened at the vertex, and then a band- 
age is to be bound round the forehead, and a 



On the Articulations 



proper apparatus is to be put over all, to pre- 
vent the bandages from being displaced. The 
patient should lie upon the sound side of the 
jaw, not resting upon the jaw, but upon the 
head. He is to be kept on a spare diet for ten 
days, and then nourished without delay. If there 
be no inflammation during the first days, the 
jaw is consolidated in twenty days; for callus 
quickly forms in this, as in ail the other porous 
bones, provided there be no sphacelus (exfoli- 
ation?). But much remains to be said on the 
sphacelus of bones in another place. This meth- 
od of distention with glued substances is mild, 
of easy application, and is useful for many dis- 
locations in many parts of the body. Those phy- 
sicians who have not judgment combined with 
their dexterity, expose themselves in fractures 
of the jaws, as in other cases, for they apply a 
variety of bandages to a fractured jaw-bone, 
sometimes properly, and sometimes improper- 
ly. For all such bandaging of a fractured jaw- 
bone has a tendency rather to derange the bones 
connected with the fracture, than to bring them 
into their natural position. 

34. But if the lower jaw be disjointed at its 
symphysis in the chin (there is but one sym- 
physis in the lower jaw, but there are several in 
the upper; but I am unwilling to digress from the 
subject, as these matters will have to be touched 
upon in other kinds of disease) if, then, the 
symphysis be separated at the chin, it is the work 
which anybody can perform, to rectify it; for 
the part which protrudes is to be pushed in- 
ward by pressure with the fingers, and the part 
that inclines inward is to forced outward by 
pushing with the fingers from within. It is aft- 
er having applied extension to separate the frag- 
ments that this is to be done, for they will thus 
be more easily restored to their natural position, 
than if one should bring them together by us- 
ing force. This is proper to be known as apply- 
ing to all such cases. When you have set the 
parts, you must fasten the teeth on both sides to 
one another, as formerly directed. The treat- 
ment is to be accomplished with cerate, a few 
compresses, and bandages. This part, in partic- 
ular, requires a short but complex (?) band- 
aging, for it is nearly cylindrical, though not 
exactly so; but the turn of the bandage is to be 
made, if the right jaw was dislocated, to the 
right hand (that is said to be to the right hand 
when the right hand conducts the bandaging) ; 
but if the other jaw be the seat of the disloca- 
tion, the bandaging is to be made in the other 
direction. And if matters be properly adjusted, 
and the patient keep quiet, there will be a speedy 



IOI 

recovery, and the teeth will be uninjured; but 
if not, the recovery will be more protracted, the 
teeth will be distorted, will give trouble, and be- 
come useless. 

35. Of fractures of the nose there are more 
than one variety, but those who, without judg- 
ment, delight in fine bandagings,do much mis- 
chief, most especially in injuries about the nose. 
For this is the most complex of all the forms of 
bandaging, havingmost of the turns of the band- 
age called "ascia," and rhomboidal intervals and 
uncovered spaces of the skin. As has been said, 
those who practice manipulation without judg- 
ment are fond of meeting with a case of frac- 
tured nose, that they may apply the bandage. 
For a day or two, then, the physician glories in 
his performance, and the patient who has been 
bandaged is well pleased, but speedily the pa- 
tient complains of the incumbranceof the band- 
age, and the physician is satisfied, because he 
has had an opportunity of showing his skill in 
applying a complex bandage to the nose. Such 
a bandaging does everything the very reverse 
of what is proper; for, in the first place, those 
who have their nose flattened by the fracture, 
will clearly have the part rendered still more 
flat, if pressure above be applied to it; and fur- 
ther, those cases in which the nose is distorted 
to either side, whether at the cartilage or higher 
up, will evidently derive no benefit from band- 
aging above it, but will rather be injured; for 
it will not admit of having compresses properly 
arranged on either side of the nose, and indeed, 
persons applying this bandage do not seek to 
do this. 

36. This bandaging would appear to me to 
answer best when the skin surrounding the bone 
is contused on its ridge near the middle, or if 
the bone itself have sustained some injury, but 
not a great one, in such cases, redundant callus 
forms in the nose, and the part becomes a little 
too prominent; and yet, even in these cases, the 
bandaging need not require much trouble, if, 
indeed, any bandage be applied at all; for it is 
enough if one lay a waxed compress on the con- 
tusion, and then apply the double-headed band- 
age, thus taking one turn with it. The best ap- 
plication to such accidents is a small cataplasm 
of wheaten flour, washed, and mixed up into a 
viscid mass. If the flour be made from good 
wheat, and if it be glutinous, it should be used 
alone for all such cases, but if it be not very 
glutinous, a little of the manna of frankincense, 
well pulverized, is to be moistened with water, 
and the flour is to be mixed up with it, or a very 
little gum may be mixed in like manner. 



ioi Hippocrates 

37. In those cases in which the fractured por- 
tions are depressed and flattened, if it is depres- 
sed in front at the cartilage, something may be 
introduced into the nostrils to rectify the parts. 
If not, all such deformities may be restored by 
introducing the fingers into the nostrils, if this 
can be managed, but if not, a thick spatula is to 
be introduced with the fingers, not to the fore 
part of the nose, but to the depressed portion, 
and the physician is to take hold of the nose ex- 
ternally on both sides, and at the same time 
raise it up. And if the fracture be much in the 
fore part one may introduce into the nostrils as 
already stated, eithercaddis scraped from a linen 
towel, or something such wrapped up m a piece 
of cloth, or rather stitched in Carthaginian leath- 
er,and moulded intoashapesuitnble totheplace 
into which it is to be introduced. But if the frac- 
ture be at a greater distance, it is not possible to 
introduce anything within, for if it was irksome 
to bear anything of the kind in the fore part, 
how is it not to be so when introduced farther 
in? At first, then, by rectifying the parts from 
within, and sparing no pains upon them from 
without, they are to be brought to their natural 
position, and set. A fractured nose may be read- 
ily restored to shape, especially on the day of 
the accident, or even a little later, but the phy- 
sicians act irresolutely, and touch it more deli- 
cately at first than they should; for the fingers 
should be applied on both sides along the nat- 
ural line of the nose, and it is to be pushed 
downward, and thus, with pressure trom with- 
in, the displacement is to be rectified. But for 
these purposes no physician is equal to the in- 
dex-fingers of the patient himself, if he will pay 
attention and has resolution, for they are the 
most natural means. Either of the fingers is to 
be placed firmly along the whole nose, and thus 
it is to be gently held, and steadily, if possible 
until it become firm, but if not, he himself is to 
hold it for as long a time as possible, in the man- 
ner described; or if he cannot, a child or wom- 
an should do it, for the hands ought to be soft. 
Thus may a fracture of the nose, attended with 
depression, and not with displacement to the 
side, but in a straight line, be most properly 
treated. I have never seen a case of fractured 
nose which could not be rectified when attempt- 
ed, before callus is formed, provided the treat- 
ment be properly applied. But although men 
would give a great price to escape being de- 
formed, yet at the same time they do not know 
how to take care, nor have resolution, if they 
do not experience pain, nor fear death, although 
the formation of callus in the nose speedily takes 



place, for the most part is consolidated in ten 
days, provided sphacelus do not take place. 

38. When the fractured bone is displaced later- 
ally, the treatment is the same, but it is obvious 
that the reduction is to be made, not by apply- 
ing equal force on both sides, but by pushing 
the displaced portion into its natural position, 
and pressing on it from without, and intro- 
ducing something into the nostrils, and bold- 
ly rectifying the fragments which incline in- 
ward, until the whole be properly adjusted, well 
knowing that if you do not restore the parts at 
once, it is impossible but that the nose must be 
distorted. But when you restore the parts to their 
natural position, either the patient himself, or 
somcother person, is to apply one finger or more 
to the part which protrudes, and keep it in posi- 
tion until the fracture be consolidated; but the 
little finger is, from time to time, to be pushed 
into the nostril, to rectify the parts which in- 
cline inward. When any inflammation super- 
venes, dough must be used, but attention must 
still be equally paid to the application of the 
fingers, although the dough be on the part. But 
if the fracture be in the cartilage, with lateral 
displacement, the end of the nose must neces- 
sarily be distorted. In such cases some of the 
aforementioned means of reduction, or what- 
ever suits, is to be introduced into the nostril; 
but there are many convenient th ings to be found 
which have no smell, and are appropriate in 
other respects; thus, on one occasion, I intro- 
duced a slice of sheep's lung, as it happened to 
be at hand; for sponges, if introduced, imbibe 
humidities. Then the outer skin of Carthagin- 
ian leather is to be taken, and a piece of the size 
of the thumb, or what will answer, is to be cut 
ofT and glued to the outside of the nostril which 
is turned aside, and then this piece of thong is 
to be stretched to the proper degree, or rather a 
little more than what will be sufficient to make 
the nose straight and regular. Then (for the 
thong must be long) it is to be brought below 
the ear and round the head, and the end of the 
thong may either be glued to the forehead, or 
a still longer one may be carried all round the 
head, and secured. This is a natural mode of 
setting the nose, is of easy application, and is 
calculated to enable the counter-extension on 
the nose to be made greater or less, as you may 
incline. In a case where the fractured nose is 
turned to the side, the treatment is to be con- 
ducted otherwise, as already described; and in 
most of them the thong ought to be glued to 
the end of the nose, in order to make extension 
in the opposite direction. 



On the Articulations 



103 



39. When the fracture is complicated with a 
wound, one need not be troubled on that ac- 
count, but pitch-cerate or any of the applica- 
tions for fresh wounds is to be applied to the 
sores; for, in general, they admit of easy cure, 
even when there is reason to apprehend that 
pieces of bone will come out. The parts, at first, 
are to be adjusted fearlessly, taking care that 
nothing is omitted, and, subsequently, they are 
also to be adjusted with the fingers; more soft- 
ly, indeed, but still it must be done; and of all 
parts of the body the nose is modeled with the 
greatest ease. And there is nothing to prevent 
us from having recourse to the practice of glu- 
ing on the thongs, and drawing the nose to the 
opposite side, even if there be a wound or the 
parts be inflamed, for these thongs give no 
pain. 

40. In fractures of the ear all sorts of band- 
ages do harm. For one would not think of ap- 
plying it quite loose, and if applied more tight- 
ly, it only does the more harm, for even the 
sound ear, when confined with a bandage, be- 
comes painful, throbs, and gets into a febrile 
state. With regard to cataplasms, the heaviest, 
on the whole, are the worst; but almost all kinds 
are bad, form abscesses, occasion an increase 
of humors, and afterward troublesome suppu- 
rations; and a fractured ear stands in less need 
of such applications than any other part; the 
most ready, if required, is the paste of meal, but 
neither should it have weight. It should touch 
as little as possible; for it is a good remedy some- 
times to apply nothing at all, both to the ear and 
to many other cases. Attention must be paid to 
the patient's position during sleep. And the body 
must be reduced, more especially if there be 
danger lest the ear suppurate; it will also be 
better to open the bowels, and if the patient can 
be readily made to vomit, this may be accom- 
plished by means of the syrmaism. If the part 
come to suppuration, it should not be hastily 
opened; for often when matter appears to be 
formed it is absorbed again, even when no cata- 
plasm is applied. But if forced to open it, the 
part will get soonest well if transfixed with a 
cautery, and yet it should be well understood 
that the ear gets maimed, and is less than the 
other if burned through. If not burned through, 
an incision, and not a very small one, should be 
made on the upper side; for the pus is found to 
be surrounded with a thicker covering than one 
would have supposed ; and it may be said, in gen- 
eral, that all parts of a mucous nature and which 
form mucus, as being all viscid, when touched, 
slip from below the fingers to either side; and on 



that account the physician, in such cases, finds 
that he has to pass his instrument through a 
thicker substance than he supposed; and in cer- 
tain ganglionic cases, when the skin is flabby and 
mucous, many physicians open them, expecting 
to find a collection in them; here the physician 
forms a wrong judgment, but by such a pro- 
cedure no great harm results to the patient from 
having had the part opened. But with regard 
to watery parts, and such as are filled with mu- 
cus, and which are situated in regions where 
every one of the parts, if opened, will occasion 
death or some other injury, these will be treated 
of in another work. When, therefore, incision 
is made in the ear, all sorts of cataplasms and 
pledges should be avoided, and it is to be treated 
cither with applications for recent wounds, or 
anything else which is neither heavy nor will 
occasion pain, for if the cartilage be laid bare 
and abscesses form, the case will be troublesome; 
this happens from such modes of treatment. In 
all aggravated cases, the most effectual remedy 
is the transfixing of the part with a hot iron. 

41. The vertebra; of the spine when contract- 
ed into a hump behind from disease, for the 
most part cannot be remedied, more especially 
when the gibbosity is above the attachment of 
the diaphragm to the spine. Certain of those be- 
low the diaphragm are carried of! by varices in 
the legs, more especially by such as occur in the 
vein at the ham; and in those cases where the 
gibbosities are removed, the varices take place 
also in the groin; and some have been carried 
off by a dysentery when it becomes chronic. And 
when the gibbosity occurs in youth before the 
body has attained its full growth, in these cases 
the body does not usually grow along the spine, 
but the legs and the arms are fully developed, 
whilst the parts (about the back) are arrested 
in their development. And in those cases where 
the gibbosity is above the diaphragm, the ribs 
do not usually expand properly in width, but 
forward, and the chest becomes sharp-pointed 
and not broad, and they become affected with 
difficulty of breathing and hoarseness; for the 
cavities which inspire and expire the breath do 
not attain their proper capacity. And they are 
under the necessity of keeping the neck bent 
forward at the great vertebra, in order that their 
head may not hang downward; this, therefore, 
occasions great contraction of the pharynx by 
its inclination inward; for, even in those who 
are erect in stature, dyspnoea is induced by this 
bone inclining inward, until it be restored to its 
place. From this frame of body, such persons 
appear to have more prominent necks than per- 



104 



Hippocrates 



sons in good health, and they generally have 
hard and unconcocted tubercles in the lungs, 
for the gibbosity and the distension are pro- 
duced mostly by such tubercles, with which the 
neighboring nerves communicate. When the 
gibbosity is below the diaphragm, in some of 
these cases nephritic diseases and affections of 
the bladder supervene, but abscesses of a chronic 
nature, and difficult to cure, occur in the loins 
and groins, and neither of these carries of! the 
gibbosity; and in these cases the hips are more 
emaciated than when the gibbosity is seated 
higher up; but the whole spine is more elon- 
gated in them than in those who have the gib- 
bosity seated higher up, the hair of the pubes 
and chin is of slower growth and less developed, 
and they are less capable of generation than 
those who have the gibbosity higher up. When 
the gibbosity seizes persons who have already 
attained their full growth, it usually occasions 
a crisis of the then existing disease, but in the 
course of time some of them attack, as in the 
case of younger persons, to a greater or less de- 
gree; but, for the most part, all these diseases 
are less malignant. And yet many have borne 
the a fleet ion well, and have en joyed good health 
until old age, more especially those persons 
whose body is inclined to be plump and fat; 
and a few of them have lived to beyond sixty 
years ot age, but the most of them are more 
short-lived. In some cases the curvature of the 
spine is lateral, that is to say, either to the one 
side or the other ; the most of such cases are con- 
nected with tubercles (abscesses?) within the 
spine; and in some, the positions in which they 
have been accustomed to lie co-operate with the 
disease. But these will be treated of among the 
chronic aflectionsofthelungs;t"orthesethemost 
suitable prognostics of what will happen in these 
cases are given. 

42. When the spine protrudes backward, in 
consequence of a fall, it seldom happens that 
one succeeds in straightening it. Wherefore suc- 
cussion on a ladder has never straightened any- 
body, as far as I know, but it is principally prac- 
ticed by those physicians who seek to astonish 
the mob for to such persons these things ap- 
pear wonderful, for example, if they see a man 
suspended or thrown down, or the like; and 
they always extol such practices, and never give 
themselves any concern whatever may result 
from the experiment, whether bad or good. But 
the physicians who follow such practices, as far 
as I have known them, are all stupid. The de- 
vice, however, is an old one, and I give great 
praise to him who first invented this, and any 



other mechanical contrivance which is accord- 
ing to nature. For neither would I despair, but 
that if succussion were properly gone about, the 
spine, in certain cases, might be thereby recti- 
fied. But, indeed, for my own part, I have been 
ashamed to treat all such cases in this way, be- 
cause such modes of procedure are generally 
practiced by charlatans. 

43. Those cases in which the gibbosity is near 
the neck, are less likely to be benefited by these 
succussions with the head downward, for the 
weight of the head, and tops of the shoulders, 
when allowed to hang down, is but small; and 
such cases are more likely to be made straight 
by succussion applied with the feet hanging 
down, since the inclination downward is greater 
in this way. When the hump is lower down, it 
is more likely in this case that succussion with 
the head downward should do good. If one, 
then, should think of trying succussion, it may 
be applied in the following manner: The lad- 
der is to be padded with leather lined cushions, 
laid across, and well secured to one another, to 
a somewhat greater extent, both in length and 
breadth, than the space which the man's body 
will occupy; he is then to be laid on the ladder 
upon his back, and the feet, at the ankles, are 
to be fastened, at no great distance from onean- 
other, to the ladder, with some firm but soft 
band; and he is further to be secured, in like 
manner, both above and below the knee, and al- 
so at the nates; and at the groins and chest loose 
shawls are to be put round in such a fashion as 
not to interfere with the effect of the succussion; 
and his arms are to be fastened along his sides 
to his own body, and not to the ladder. When 
you have arranged these matters thus, you must 
hoist up the ladder, either to a high tower or to 
the gable-end of a house; but the place where 
you make the succussion should be firm, and 
those who perform the extension should be well 
instructed, so that they may let go their hold 
equally to the same extent, and suddenly, and 
that the ladder may neither tumble to the ground 
on either side, nor they themselves fall forward. 
But, if the ladder be let go from a tower, or the 
mast of a ship, fastened into the ground with 
its cordage, it will be better, so that the ropes 
run upon a pulley or axle-tree. But it is dis- 
agreeable even to enlarge upon these matters; 
and yet, by the contrivances now described, the 
proper succussion may be made. 

44. But if the hump be situated very high up, 
and if succussion be by all means to be used, it 
will be better to do it with the feet downward, 
as has been said, for the force downward will 



On the Articulations 



105 



be the greater in this case. The patient is to be 
well fastened to the ladder by cords at the breast, 
at the neck by means of a very loose shawl so as 
merely to keep the part properly on the ladder, 
and the head is to be fastened to the ladder at 
the forehead, the arms are to be stretched along 
and attached to the patient's body, and not to 
the ladder, and the rest of the body is not to be 
bound, except so as to keep it in place by means 
of a loose shawl wrapped round it and the lad- 
der; attention, moreover, should be paid that 
these ligatures do not interfere with the force 
of the succussion, and the legs are not to be fas- 
tened to the ladder, but should be placed near 
one another, so as to be in line with the spine. 
These matters should be thus arranged, if re- 
course is to be had at all to succussion on a lad- 
der; for it is disgraceful in every art, and more 
especially in medicine, after much trouble, much 
display, and much talk, to do no good after all. 
45. In the first place, the structure of the spine 
should be known, for this knowledge is requi- 
site in many diseases. Wherefore, on the side 
turned to the belly (the anterior?) the vertebra: 
are in a regular line, and are united together 
by a pulpy and nervous band of connection, 
originating from the cartilages, and extending 
to the spinal marrow. There are certain other 
nervous cords which decussate, are attached (to 
the vertebrce?), and are extended from both 
sides of them. But we will describe in another 
work the connections of the veins and arteries, 
their numbers, their qualities, their origin, their 
functional offices in particular parts, in what 
sort of sheaths the spinal marrow is inclosed, 
where they arise, where they terminate, how 
they communicate, and what their uses. On the 
opposite side (behind?) the vertebra: are con- 
nected together by a ginglymoid articulation. 
Common cords (nerves?) are extended to all 
parts, both those within and without. There is 
an osseous process from the posterior part of all 
and each of the vertebra:, whether greater or 
smaller; and upon these processes there are car- 
tilaginous epiphyses,and from them arise nerv- 
ous productions (ligaments?), akin to the ex- 
ternal nerves (rovoi). The ribs are united to 
them, having their heads inclined rather to the 
inside than the out, and every one of them is 
articulated with the vertebra?; and the ribs in 
man are very curved, and, as it were, arched. 
The space between the ribs and the processes 
of the vertebra? is filled on both sides by mus- 
cles, which arise from the neck and extend to 
the loins (?). The spine, longitudinally, is a 
straight line slightly curved; from the os sacrum 



to the great vertebra which is connected with 
the articulation of the femur, the spine inclines 
backward, for the bladder, the organs of gen- 
eration, and the loose portion of the rectum, are 
situated there. From this, to the attachment of 
the diaphragm, the spine inclines inward, and 
this portion alone, from the internal parts, gives 
origin to muscles, which are called psoce. From 
this to the great vertebra (seventh cervical?) 
which is above the tops of the shoulders, it is 
convex behind lengthways; but it is more in 
appearance than it really is, for the spinous 
processes are highest in the middle, and less 
so above and below. The region of the neck 
is convex before. 

46. In cases of displacement backward along 
the vertebra?, it does not often happen, in fact, 
it is very rare, that one or more vertebra? are 
torn from one another and displaced. For such 
injuries do not readily occur, as the spine could 
not easily be displaced backward but by a se- 
vere injury on the fore part through the belly 
(which would prove fatal), or if a person fall- 
ing from a height should pitch on the nates, or 
shoulders (and even in this case he would die, 
but not immediately); and it also would not 
readily happen that such a displacement could 
take place forward, unless some very heavy 
weight should fall upon it behind; for each of 
the posterior spinal processes is so constructed, 
that it would sooner be broken than undergo 
any great mcl ination forward from a force which 
would have to overcome the ligaments and the 
articulations mutually connecting them. And 
the spinal marrow would sufTer, it from the 
displacement oi a vertebra it were to be bent 
even to a small extent; for the displaced verte- 
bra would compress the spinal marrow, if it did 
not break it; and if compressed and strangled, 
it would induce insensibility of many great and 
important parts, so that the physician need not 
give himself any concern about rectifying the 
displacement of the vertebra, accompanied, as 
it is, by many other ill consequences of a serious 
nature. It is evident, then, that such a case could 
not be reduced either by succussion or by any 
other method, unless one were to cut open the 
patient, and then, having introduced the hand 
into one of the great cavities, were to push out- 
ward from within, which one might do on the 
dead body, but not at all on the living. Where- 
fore, then, do I write all this? Because certain 
persons fancy that they have cured patients in 
whom the vertebra had undergone complete 
dislocation forward. Some, indeed, suppose that 
this is the easiest of all these dislocations to be 



106 Hippocrates 

recovered from, and that such cases do not stand 
in need of reduction, but get well spontaneous- 
ly. Many are ignorant, and profit by their igno- 
rance, for they obtain credit from those about 
them. These are deceived in this way, for they 
suppose the spinous processes to be the verte- 
bra: themselves, because every one of them ap- 
pears round to the touch, not knowing that these 
bones are processes from the vertebrae, as for- 
merly stated; but the vertebrae are at a consid- 
erable distance before them; for of all animals, 
man, in proportion to his bulk, has the belly 
(internal cavity?) the narrowest from behind 
to before, especially at the breast. When, there- 
fore, any of these processes arc severely fractured, 
whether one or more, the part there appears 
lower than on either side, and for that reason 
they are deceived, supposing that the vertebra: 
arc displaced in ward. And theattitudes of the pa- 
tient contribute also to deceive them; for if they 
attempt to put themselves into a bent position, 
they are pained, from the skin being stretched 
at the seat of the injury, and at the same time 
the fragments of the bones wound the skin still 
more; but if they bend forward, they feel easier, 
for the skin at the wound is thus relaxed, and 
the bones are less disposed to hurt them; and if 
touched, they shrink and bend forward, and the 
part which is touched appears empty and soft. 
All thecircumstances now mentioned contribute 
to deceive the physician. Such patients speedily 
get well without any bad effects, for callus 
readily forms in all such bones as are porous. 

47. There are many varieties of curvature of 
the spine even in persons whoare in good health; 
for it takes place irorn natural con formation and 
from habit, and the spine is liable to be bent 
from old age, ami irorn pains. Gibbosities (or 
projections backward) from falls generally take 
place when one pitches on the nates, or falls on 
the shoulders. In this case some one of the verte- 
bra: must necessarily appear higher than natu- 
ral, and those on cither side to a less degree; but 
yet no one generally has started out of the line 
of the others, but every one has yielded a little, 
so that a considerable extent of them is curved. 
On this account the spinal marrow easily bears 
such distortions, because they are of a circular 
shape, and not angular. The apparatus for the 
reduction in this case must be managed in the 
following manner: a strong and broad board, 
having an oblong furrow in it, is to be fastened 
in the ground, or, in place of the board, we may 
scoop out an oblong furrow in the wall, about 
a cubit above the floor, or at any suitable height, 
and then something like an oaken bench, of a 



quadrangular shape, is to be laid along (the 
wall?) at a distance from the wall, which will 
admit of persons to pass round if necessary, and 
the bench is to be covered with robes, or any- 
thing else which is soft, but does not yield much; 
and the patient is to be stoved with vapor, if 
necessary, or bathed with much hot water, and 
then he is to be stretched along the board on his 
face, with his arms laid along and bound to his 
body; the middle, then, of a thong which is soft, 
sufficiently broad and long, and composed of 
two cross straps of leather, is to be twice carried 
along the middle of the patient's breast, as near 
the armpits as possible, then what is over of the 
thongs at the armpits is to be carried round the 
shoulders, and afterward the ends of the thong 
are to be fastened to a piece of wood resembling 
a pestle; they are to be adapted to the length of 
the bench laid below the patient, and so that 
the pestle-like piece of wood resting against this 
bench may make extension. Another such band 
is to be applied above the knees and the ankles, 
and the ends of the thongs fastened to a similar 
piece of wood; and another thong, broad, soft, 
and strong, in the form of a swathe, having 
breadth and length sufficient, is to be bound 
tightly round the loins, as near the hips as pos- 
sible; and then what remains of this swathe- 
like thong, with the ends of the thongs, must 
be fastened to the piece of wood placed at the 
patient's feet, and extension in this fashion is to 
be made upward and downward, equally and 
at the same time, in a straight line. For exten- 
sion thus made could do no harm, if properly 
performed, unless one sought to do mischief 
purposely. But the physicians, or some person 
who is strong, and not uninstructed, should ap- 
ply the palm of one hand to the hump, and then, 
having laid the other hand upon the former, he 
should make pressure, attending whether this 
force should be applied directly downward, or 
toward the head, or toward the hips. Thismeth- 
od of applying force is particularly safe; and it 
is also sale for a person to sit upon the hump 
while extension is made, and raising himself 
up, to let himself fall again upon the patient. 
And there is nothing to prevent a person from 
placing a foot on the hump, and supporting his 
weight on it, and making gentle pressure; one 
of the men who is practiced in the palestra would 
be a proper person for doing this in a suitable 
manner. But the most powerful of the mechan- 
ical means is this: if the hole in the wall, or in 
the piece of wood fastened into the ground, be 
made as much below the man's back as may be 
judged proper, and if a board, made of lime- 



On the Articulations 



107 



tree, or any other wood, and not too narrow, be 
put into the hole, then a rag, folded several times 
or a small leather cushion, should be laid on 
the hump; nothing large, however, should be 
laid on the back, but just as much as may pre- 
vent the board from giving unnecessary pain 
by its hardness; but the hump should be as much 
as possible on a line with the hole made in the 
wall, so that the board introduced into it may 
make pressure more especially at that spot. 
When matters are thus adjusted, one person, or 
two if necessary, must press down the end of 
the board, whilst others at the same time make 
extension and counter-extension along the body, 
as formerly described. Extension may also be 
made with axles, which may either be fastened 
in the ground beside the bench, or the post of 
the axles may be attached to the bench itself, if 
you will make them perpendicular and over- 
topping (the bench?) a little at both ends, or at 
either end of the bench. These powers are easily 
regulated, so as to be made stronger or weaker, 
and they are of such force, that if one were to 
have recourse to them for a mischievous pur- 
pose, and not as a remedy, they would operate 
strongly in this way also; for by making merely 
extension and counter-extension longitudinally, 
without any additional force, one might make 
sufficient extension; and if, without making ex- 
tension at all, one were only to press down prop- 
erly with the board, sufficient force might be 
applied in this way. Such powers, then, arc ex- 
cellent which admit of being so regulated, that 
they can be made weaker and stronger as re- 
quired. And the forces are applied in the natu- 
ral way; for the pressure above forces the dis- 
placed parts into their place. Natural extension 
restores parts which have come too near one an- 
other to their natural position. I, then, am ac- 
quainted with no powers which are better or 
more appropriate than these; for extension a- 
long the spine downward has no proper hold at 
the bone called the os sacrum; and extension 
upward, along the neck and head, has indeed a 
hold; but extension thus made is unseemly to 
behold, and, besides, if increased, may occasion 
much mischief otherwise. I once made trial of 
the following plan. Having placed the patient 
on his back, I put below the hump a bladder, 
not inflated, and afterward introduced air into 
the bladder bv means of a brass pipe connected 
with it. But the experiment did not succeed; for, 
when the man was fairly extended, the bladder 
yielded, and the air could not be forced into it; 
and, besides, the hump of the patient was apt to 
slip off the distended bladder when they were 



pressed together. But when I did not extend 
the man strongly, the bladder was swelled up 
by the air, and the man became more bent for- 
ward than proper. I have written this expressly; 
for it is a valuable piece of knowledge to learn 
what things have been tried and have proved 
ineffectual, and wherefore they did not suc- 
ceed. 

48. In curvatures forward of the vertebra: 
from a fall, or from some heavy body fall ing up- 
on them, in general no one of them is displaced 
far beyond the others, but if one or more be so 
displaced, the case proves fatal; but, as former- 
ly stated, the displacement is circular, and not 
angular. In such cases, then, the urine and l.rces 
are more apt to be retained than in displace- 
ment outward, the feet and the whole inferior 
extremities are colder, and the symptoms are 
more fatal than in the former case; and if they 
do survive, they are more subject to retention 
of the urine, and to loss of strength, and to tor- 
por in their legs. Hut if the displacement be in 
the upper part, they experience loss of strength 
and torpor of the whole body. I know no me- 
chanical contrivance by which such a displace- 
ment could be reduced, unless that one might 
be benefited by succussion on a bladder, or any 
other similar plan of treatment, such as exten- 
sion, as formerly described. I am not aware of 
any mode of pressure which might be applied 
along with the extension, like that of the board 
in displacement backward; for how could one 
apply pressure from before through the belly? 
(internal cavity?) The thing is impossible. But 
neither coughing nor sneezing has auy power 
so as to co-operate with the extension, nor would 
the injection of air into the bowels have any ef- 
fect. And to apply large cupping instruments 
with the view of drawing back the vertebra? 
which have protruded forward, shows a great 
error of judgment; for they rather propel than 
attract, and those who apply them are not aware 
even of this fact, for the greater will be the in- 
clination forward the greater the instrument ap- 
plied, the skin being forcibly drawn into the 
cupping-instrument. I could tell of other modes 
of succussion than those formerly described, 
which one might fancy would be more appli- 
cable in such an affection; but I have no great 
confidence in them, and therefore I do not de- 
scribe them. On the main, it should be known, 
respecting the accidents which I have briefly de- 
scribed, that displacements forward are of a fa- 
tal and injuriousnature; but that displacements 
backward, for the most part, do not prove fatal, 
nor occasion retention of urine nor torpor of 



io8 Hippocrates 

the limbs, for they do not stretch the ducts lead- 
ing toward the intestines, nor occasion obstruc- 
tion of the same; but displacements forward 
produce both these bad effects, and many oth- 
ers in addition. And truly they are more apt to 
lose the power of their legs and arms, to have 
torpor of the body, and retention of urine, who 
experience no displacement either forward or 
backward, but merely a violent concussion a- 
long the spine, while those who have displace- 
ment backward are least subject to these symp- 
toms. 

49. And one might observe many other in- 
stances in medicine, of considerable in juries not 
proving serious, but producing a crisis in some 
affection, while less considerable injuries prove 
more serious, give rise to chronic diseases, and 
extend their effects to the whole system. Now 
something similar may happen in fracture of 
the ribs; for in fracture of one or more ribs, in 
general, if the fractured bones are not driven 
inward, nor are laid bare, fever rarely super- 
venes, neither does it often happen that there is 
haemoptysis, empyema, and suppurating sores, 
which require treatment with pledgets, nor ne- 
crosis of the bones; and in these cases the ordi- 
nary regimen is sufficient. For, unless they be 
seized with continual fever, a strict diet does 
more harm than good, by inducing inanition, 
and increasing the pain, fever, and cough; for 
moderate fullness of the intestines has a tend- 
ency to replace the ribs, while evacuation leads 
to suspension of the ribs, and suspension in- 
duces pain. Ordinary bandaging, externally, is 
sufficient in such cases; the bandages should be 
applied moderately tight, along with cerate and 
compresses, or a pad of wool may be applied. 
The rib is consolidated in twenty days, for cal- 
lus soon forms in such bones. 

50. But when there is contusion of the flesh 
about the ribs, either from a blow, or a fall, or 
a bruise, or any like cause, there is often copious 
vomiting of blood, for there are canals stretch- 
ed along the vacuity of each rib (intercostal 
space?), and nerves proceeding from the most 
important parts of the body have their origin 
there. Many of these, therefore, are troubled 
with coughs, tubercles, empyema, external sup- 
purations, and sphacelus of the ribs. And even 
when no such symptoms supervene from con- 
tusion of the skin about the ribs, still in such 
cases there is, generally, more combined pain 
than in fractures of the ribs, and relapses of pain 
in the scat of the injury are more apt to occur. 
Wherefore some physicians pay much less at- 
tention to such injuries, than where the rib is 



fractured, whereas, if they were wise, they would 
treat such cases with far greater care than the 
other; for it is proper that the diet should be re- 
stricted, that the patients should remain at rest 
as much as possible, and abstain from venery, 
from fat articles of food, from such as excite 
cough, and from every thing strong; they should 
be bled in the arm, speak as little as possible, 
should have the contused part bound round 
with folded compresses, plenty of bandages, 
broader than the contusion, and which should 
be smeared with cerate; in applying the band- 
ages, broad and soft shawls should be used, and 
they should be put on moderately firm, so that 
the patient will say that they are neither too tight 
nor loose, and the bandaging should commence 
at the seat of the injury, and be made more par- 
ticularly tight there, and the bandaging should 
be conducted as is done with a double-headed 
roller, so that the skin about the ribs may not 
be ruffled, but may lie smooth, and the band- 
aging should be renewed every day, or every al- 
ternate day. It is better also to open the bowels 
with some gentle medicine, soas just to produce 
an evacuation of the food, and the diet is to be 
restricted for ten days, and then the body is to 
be recruited and filled up; while you are upon 
the reducing system, the bandaging should be 
tighter, but when you are making him up again, 
it must be looser; and, if he spit blood from the 
commencement, the treatment and bandaging 
should be continued for forty days; but if there 
be no hemoptysis, treatment for twenty days 
will generally be sufficient; but the length of 
time must be regulated by the magnitude of the 
injury. When such contusions are neglected, if 
no greater mischief result therefrom, at all 
events the bruised part has its flesh more pulpy 
than it had formerly. When, therefore, any such 
thing is left behind, and is not properly dissi- 
pated by the treatment, it will be worse if the 
mucosity be lodged near the bone, for the flesh 
no longer adheres to the bone as formerly, the 
bone becomes diseased, and chronic sloughings 
of the bone in many cases a rise from such causes. 
But if the mischief be not upon the bone, but it 
is the flesh itself which is pulpy, relapses and 
pains will return from time to time, if there 
happen to be any disorder in the body; where- 
fore proper bandaging, and for a considerable 
time, must be had recourse to, until the extrav- 
asated blood forming in the bruise be dried up 
and absorbed, and the part be made up with 
sound flesh, and the flesh adhere to the bone. 
The best cure is the cautery in those cases which, 
from neglect, have become chronic, and the 



On the Articulations 



109 



place turns painful, and the flesh is pulpy. And 
when the flesh itself is pulpy, the burningshould 
be carried as far as the bone, but the bone itself 
should not be heated; but if it be in the inter- 
costal space, you need not make the burning so 
superficial, only you must take care not to burn 
quite through. But if the contusion appear to 
be at the bone, if it be still recent, and the bone 
has not yet become necrosed, if it be very small, 
it is to be burned as has been described; but if 
the rising along the bone be oblong, several es- 
chars are to be burned over it. Necrosis of the 
rib will be described along with the treatment 
of suppurating sores. 

51. There are four modes of dislocation at the 
hip-joint: of which modes, dislocation inward 
takes place most frequently, outward, the most 
frequently of all the other modes; and it some- 
times takes place backward and forward, but 
seldom. When, therefore, dislocation takes place 
inward, the leg appears longer than natural, 
when compared with the other leg, for two rea- 
sons truly; for the bone which articulates with 
the hip-joint is carried from above down to the 
ischium where it rises up to the pubes, upon it, 
then, the head of the femur rests, and the neck 
of the femur is lodged in the cotyloid foramen 
(foramen thyroideum?) . The buttock appears 
hollow externally, from the head of the thigh- 
bone having shifted inward, and the extremity 
of the femur at the knee is turned outward, and 
the leg and foot in like manner. The foot then 
being turned outward, physicians, from igno- 
rance, bring the sound leg to it and not it to the 
sound leg; on this account, the injured limb ap- 
pears to be much longer than the sound one, and 
in many other cases similar circumstances lead 
to error in judgment. Neither does the limb at 
the groin admit of flexion as in the sound limb, 
and the head of the bone is felt at the perineum 
too prominent. These, then, are the symptoms 
attending dislocation of the thigh inward. 

52. When, then, a dislocation has not been re- 
duced, but has been misunderstood or neglected, 
the leg, in walking, is rolled about as is the case 
with oxen, and the weight of the body is most- 
ly supported on the sound leg, and the limb at 
the flank, and the joint where the dislocation has 
occurred is necessarily hollow and bent, while 
on the sound side the buttock is necessarily 
rounded. For if one should walk with the foot 
of the sound leg turned outward, the weight of 
the body would be thrown upon the injured 
limb, but the injured limb could not carry it, for 
how could it? One, then, is forced in walking 
to turn the leg inward, and not outward, for 



thus the sound leg best supports its own half of 
the body, and also that of the injured side. But 
being hollow at the flank and the hip-joint, they 
appear small in stature, and are forced to rest 
on a staff at the side of the sound leg. For they 
require the support of a staff there, since the 
nates inclines to this side, and the weight of the 
body is carried to it. They are forced also to 
stoop, for they are obliged to rest the hand on 
the side of the thigh against the affected limb; 
for the limb which is injured cannot support 
the body in changing the legs, unless it be held 
when it is applied to the ground. They who have 
got an unreduced dislocation inward are forced 
to put themselves into these attitudes, and this 
from no premeditation on their part how they 
should assume the easiest position, but the im- 
pediment itself teaches them to choose that 
which is most conformable to their present cir- 
cumstances. For persons who have a sore on 
the foot, or leg, and cannot rest upon the limb, 
all, even children, walk in this way; for they 
turn the injured limb outward in walking, and 
they derive two advantages therefrom, to sup- 
ply two wants; the weight of the body is not 
equally thrown upon the limb turned outward, 
as upon the one turned inward, for neither is 
the weight in a line with it, but is much more 
thrown upon the one under the body; for the 
weight is in a straight line with it, both in walk- 
ing and in the shifting of the legs. In this po- 
sition one can most quickly turn the sound 
limb under the body, by walking with the un- 
sound limb outward, and the sound inward. In 
the case we are now treating of, it is well that 
the body finds out the attitudes which are the 
easiest for itself. Those persons, then, who have 
not attained their growth at the time when 
they met with a dislocation which is not re- 
duced, become maimed in the thigh, the leg, 
and the foot, for neither do the bones grow prop- 
erly, but become shortened, and especially the 
bone of the thigh; and the whole limb is emaci- 
ated, loses its muscularity, and becomes ener- 
vated and thinner, both from the impediment 
at the joint, and because the patient cannot use 
the limb, as it does not lie in its natural position, 
for a certain amount of exercise will relieve ex- 
cessive enervation, and it will remedy in so far 
the deficiency of growth in length. Those per- 
sons, then, are most maimed who have experi- 
enced the dislocation in utero, next those who 
have met with it in infancy, and least of all, those 
who are full grown. The mode of walking 
adopted by adults has been already described; 
but those who are children when this accident 



no Hippocrates 

befalls them, generally lose the erect position of 
the body, and crawl about miserably on the 
sound leg, supporting themselves with the hand 
of the sound side resting on the ground. Some, 
also, who had attained manhood before they 
met with this accident, have also lost the faculty 
of walking erect. Those who werechildren when 
they met with the accident, and have been prop- 
erly instructed, stand erect upon the sound leg, 
but carry about a staff, which they apply under 
the armpit of the sound side, and some use a 
stall in both arms; the unsound limb they bear 
up, and the smaller the unsound limb, the great- 
er facility have they in walking, and their sound 
leg is no less strong than when both are sound. 
The fleshy parts of the limb are enervated in all 
such cases, but those who have dislocation in- 
ward are more subject to this loss of strength 
than, for the most part, those who have it out- 
ward. 

53, Some tell a story how the Amazonian 
women dislocate the joints of their male chil- 
dren while mere infants, some at the knee, and 
others at the hip-joint, that they may be maim- 
ed, and that the male sex may not conspire a- 
gainst the female, and that they use them as ar- 
tisans to perform any sedentary work, such as 
that of a shoemaker or brazier. Whether these 
things be true or not I do not know, but this I 
know, that matters would be such as is repre- 
sented, provided their children, while infants, 
were to have their joints dislocated. The conse- 
quences of dislocation inward at the hip-joint 
are much greater than of dislocation outward 
at the hip-joint, but at the knee, although there 
be some difference, it is less; but the mode of 
either impediment is peculiar, their legs are 
more bandied when the dislocation is outward, 
but those who have dislocation inward stand 
erect on their feet with less freedom. In like 
manner, when the dislocation is at the ankle- 
joint, if outward they become vari (their toes 
arc turned inward?), but they can stand; but if 
the dislocation be inward they become valgi 
(their toes are turned ottlward?), but they have 
less freedom of standing. The proportional 
growth of their bones is as follows: in those 
cases in which the bone of the leg is dislocated, 
the bones of the feet grow very little, as being 
very near the injury, but the bones of the leg in- 
crease in size, and with very little defect, but the 
fleshy parts (muscles?) are wasted. But when 
the ankle-joint is in its natural state, but the 
knee is dislocated, in these cases the bones of 
the leg do not grow in like manner, but become 
shortened, as bcingnearest the seat of the injury, 



and the bones of the feet also are atrophied, but 
not in the same proportion; because, as was said 
a little while ago, the ankle-joint is safe, and if 
they could use it, as in the case of club-foot, the 
bones of the foot would be still less atrophied. 
When the dislocation takes place at the hip- 
joint, the bone of the thigh, in this case, does 
not generally grow in like manner, as being the 
one nearest the seat of the injury, but becomes 
shorter than the sound one; but the growth of 
the bones of the leg is not arrested in like man- 
ner; nor of those of the feet, for this reason, that 
there is no displacement between the bones of 
the thigh and leg, nor between those of the leg 
and foot; in those cases, however, the fleshy parts 
of the whole limb are atrophied; but if they could 
make use of the limb, the growth of the bones 
would be still more developed, as formerly 
stated, only the thigh, although its flesh would 
be much less wasted, would still be by no means 
so fleshy as the sound limb. The following ob- 
servationsare a proof of this: those persons who 
are weasel-armed (galiancones) from birth, ow- 
ing to dislocation of the humerus, or when the 
accident has happened to them before they have 
attained their full growth, such persons have 
the bone of the arm shortened, but those of the 
fore-arm and hand are little inferior in size to 
the sound, for the reasons which have been 
stated, because the humerus is the bone nearest 
to the joint affected, and, on that account, it is 
shorter than natural; but the fore-arm is not 
equally affected by the accident, because the 
joint at which the bones of the arm and fore- 
arm are articulated remains in its natural con- 
dition, and the hand is still further distant than 
the fore-arm from the seat of the injury. Such 
are the reasons why certain of the bones in this 
case increase in growth, and certain do not. The 
laborious office of the hand contributes much to 
the development of the flesh in the fore-arm and 
hand, for whatever work is done by the hand, 
these weasel-armed persons strive to do no less 
effectually with the other hand than with the 
sound; for the arms do not support the weight 
of the body like the legs, and the work per- 
formed by them is light. From exercise, then, 
the fleshy parts on the hand and fore-arm a re not 
atrophied in weasel-armed persons, and by these 
means the arm, too, gains flesh. But in disloca- 
tion inward at the hip-joint, whether from birth 
or from childhood, the fleshy parts, on that ac- 
count, are much more atrophied than those of 
the hand, because the patients cannot exercise 
the leg. Another proof will be given in the ob- 
servations which will be presently stated, that 



On the Articulations 



these things are such as I have represented. 

54. When the head of the femur is dislocated 
outward, the limb in these cases, when compared 
with the other, appears shortened, and this is 
natural, for the head of the femur no longer 
rests on a bone as in dislocation inward, but 
along the side of a bone which naturally inclines 
to the side, and it is lodged in flesh of a pulpy 
and yielding nature, and on that account it ap- 
pears more shortened. Inwardly, the thigh about 
the perineum appears more hollow and flabby, 
but externally the buttock is more rounded, 
from the head of the thigh having slipped out- 
ward, but the nates appear to be raised up, ow- 
ing to the flesh there having yielded to the head 
of the thigh-bone; but the extremity of the 
thigh-bone, at the knee, appears to be turned in- 
ward, and the leg and foot in like manner, 
neither does it admit of flexion like the sound 
limb. These, then, are the symptoms of dislo- 
cation outward. 

55. When such a dislocation is not reduced in 
adults, the whole limb appears to be shortened, 
and in walking they cannot reach the ground 
with the heel, but they walk with the ball of the 
foot on the ground, and the points of their toes 
incline a little inward. But the injured limb, in 
this case, can support the body much better than 
in dislocation inward, both because the head of 
the femur and the neck of its articular extrem- 
ity, being naturally oblique, have formed a bed 
under a considerable portion of the hip, and be- 
cause the extremity of the foot is not forcibly 
turned outward, but is nearly in a line with the 
body, and is even inclined more inwardly. 
When, then, the articular extremity of the fe- 
mur has worn out a socket for itself in the flesh 
where it was lodged, and the flesh is lubricated, 
it ceases to be painful in the course of time, and 
when it becomes free from pain, they can walk 
without a stafl, if so inclined, and they can sup- 
port the body on the injured limb. From usage 
then, in such cases, the fleshy parts are less ener- 
vated than in those which have been mentioned 
a little before, still, however, they lose their 
strength more or less; but in general there is 
more enervation when the dislocation is inward 
than when it is outward. Some of them, then, 
cannot wear their shoes, owing to the unbend- 
ing state of their leg, and some of them can. 
But when this dislocation takes place in utero, 
and when the dislocation having occurred at 
any time before manhood, from violence, has 
not been replaced, or when from disease the ar- 
ticular extremity has started from its socket, 
and is displaced (for many such cases occur, 



III 

and from some of them, if the femur become 
necrosed, obstinate suppurations requiring the 
use of tents are formed, and in certain of them 
the bone is laid bare), whether the bone become 
necrosed or not, the bone of the thigh is much 
shortened, and does not usually grow like the 
sound one, the bones, too, of the leg, become 
shorter than those of the other, but in a small 
degree, for the same reasons that were former- 
ly stated; such persons can walk, some of them 
in the same fashion as adults having an unre- 
duced dislocation, and some of them walk with 
the whole foot on the ground, but limp in walk- 
ing, being obliged to do so by the shortness of 
the limb. Such is the result, even though they 
be carefully and properly trained in the attitudes 
before they have strength for walking, and in 
like manner also, after they have acquired the 
necessary strength; but those persons require 
the most care who were very young when they 
met with the accident, for, if neglected while 
children, the limb becomes entirely useless and 
atrophied. The fleshy parts of the entire limb 
are more wasted than those of the sound limb, 
but this is much less apt to happen in their case 
than in dislocation inward, owing to usage and 
exercise, as they are speedily able to make use 
of the limb, as was stated a little before with re- 
gard to the weasel-armed (galiancones). 

56. There are persons who, from birth or from 
disease, have dislocations outward of both the 
thighs; in them, then, the bones are afTected in 
like manner, but the fleshy parts in their case 
lose their strength less; the legs, too, arc plump 
and fleshy, except that there is some little de- 
ficiency at the inside, and they are plump be- 
cause they have the equal use of both their legs, 
for in walking they totter equally to thissideand 
that. Their nates appear very prominent, from 
the displacement of the bones of the joint. But 
if in their case the bones do not sphacelate (be- 
come carious?) and if they do not become bent 
above the hip-joint, if nothing of this kind hap- 
pen to them, they become otherwise sufficiently 
healthy, but the growth of all the rest of the body, 
with the exception of the head, is arrested. 

57. In dislocations of the head of the femur 
backward, which rarely occur, the patient can- 
not extend the leg, either at the dislocated joint, 
or at the ham, to any extent, and of all the dis- 
locations, this is the variety in which the patients 
have the least power of making extension at the 
groin and the ham. But, moreover, this also 
should be known (for it is a valuable piece of 
knowledge, and of much importance, and yet 
most people are ignorant of it), that persons in 



Hippocrates 



health cannot extend the joint at the ham, if 
they do not extend the joint at the groin at the 
same time, unless they raise the foot very high, 
for m this way they could do it; neither also 
could they bend the joint at the ham, but with 
much greater difficulty, if they do not bend the 
joint at the groin at the same time. There are 
many other things in the body which have sim- 
ilar connections, both with regard to the con- 
tractions of nerves (ligament*?), and the posi- 
tionsof muscles, and many of them more worthy 
oi being known than is generally supposed, and 
with regard to the nature ot the intestine and 
that of the whole internal cavity, and with re- 
gard to the displacements and contractionsof the 
uterus; but all these things will be treated of else- 
where, in a work akin to the present one. But 
with regard to the matter on hand, they can- 
not make extension, as has been already stated; 
and the limb appears shortened, for two rea- 
sons first, bex'ause it cannot be extended, and 
also because the bone has slipped into the flesh 
of the nates; for the head and neck of the femur, 
in this dislocation, are carried downward from 
their natural situation, to the outside of the na- 
tes. But yet they can bend the limb, unless pre- 
vented by pain, and the leg and foot appear 
pretty straight, and not much inclined toward 
either side, but at the groin the flesh, when felt, 
appears looser, from the bone of the joint hav- 
ing slipped to theotherside, but at the nates the 
head ot the lemur may be telt to be more prom- 
inent than natural. Such are the symptoms ac- 
companying dislocation of the thigh backward. 
58. When this dislocation occurs in an adult, 
and is not reduced, he can walk, indeed, alter a 
time, and when the pain has abated, and when 
he has been accustomed to rotate the articular 
bone in the flesh; he finds it necessary, however, 
to make strong flexion at the groin in walking, 
for two reasons, both because the limb, for the 
causes already stated, becomes much shorter, 
and he is far from touching the ground with 
his heel, and he can barely reach it with the ball 
of his foot, and not even thus, unless he bend 
himself at the groins, and also bend with the 
other leg at the ham. And in this case, he is un- 
der the necessity of supporting the upper part 
of the thigh with his hand at each step: this al- 
so contributes, in a certain degree, to make him 
bend the body at the groins; for, during the 
shifting of the feet in walking, the body cannot 
be supported on the unsound limb, unless it be 
pressed to the ground by the hand, the end of 
the femur not being placed properly under the 
body, but having slipped backward to the nates; 



and if he should try to rest the weight of his 
body for a little, upon the foot, without any oth- 
er support, he would fall backward, for there 
would be a great inclination in this direction, 
from the hips having protruded backward far 
beyond the line of the foot, and the spine in- 
clining toward the hips. Such persons can walk, 
indeed, without a staff, if so accustomed, for be- 
cause the sole of the foot is in its old line, and is 
not inclined outward, they do not require any- 
thing to balance them. Such, however, as, in- 
stead of grasping the thigh, prefer resting their 
weight upon a staff introduced into the armpit 
of the affected side, these, if they use a longer 
staff, will walk, indeed, more erect, but will not 
be able to reach the ground with the foot, or if 
they wish to rest upon the foot, they must take 
a shorter staff, and will require to bend the body 
at the groins. The wasting of the fleshy parts is 
analogous to what happens in the cases former- 
ly described, for the wasting is greatest in those 
cases in which the patients keep the limb up, 
and do not exercise it, whilst those who prac- 
tice walking, have the least atrophy. The sound 
leg, however, is not benefited, but is rather ren- 
dered more deformed, if the injured limb be ap- 
plied to the ground, for it is forced toco-operate 
with the other, being protruded at the hip, and 
bent at the ham. But if the patient does not use 
the injured limb by applying it to the ground, 
but carries it up, and rests upon a staff, the 
sound leg thereby gains strength, for it is em- 
ployed in its natural position, and further, the 
exercise gives it strength. But it may be said, 
these things are foreign to medicine; for what 
is the use of enlarging upon cases which are al- 
ready past remedy? This is far from being the 
case, for it belongs to the knowledge of medi- 
cine to be acquainted also with these, and they 
cannot possibly be separated from one another; 
for to such as are curable, means are to be used 
to prevent them from becoming incurable, 
studying how they may best be prevented from 
getting into an incurable state. And incurable 
cases should be known, that they may not be 
aggravated by useless applications, and splendid 
and creditable prognostics are made by know- 
ing where, how, and when every case will termi- 
nate, and whether it will be converted into a 
curable or an incurable disease. When then, 
from birth, or during one's youth, this disloca- 
tion backward occurs, and is not reduced, 
whether it be connected with violence or dis- 
ease (for many such dislocations occur in dis- 
eases, but the nature of the diseases in which 
dislocations take place, will be described after- 



On the Articulations 



ward); if, then, the dislocated limb be not re- 
duced, the bone of the thigh becomes short- 
ened, the whole limb is impaired, is arrested in 
its growth, and loses its flesh from want of use; 
the articulation at the ham is also impaired, for 
the nerves (ligaments? ) become stretched, from 
the causes formerly stated, wherefore those who 
have this dislocation, cannot make extension 
at the knee-joint. In a word, all parts of the body 
which were made for active use, if moderately 
used and exercised at the labor to which they 
are habituated, become healthy, increase in bulk, 
and bear their age well, but when not used, and 
when left without exercise, they become dis- 
eased, their growth is arrested, and they soon 
become old. Among these parts the joints and 
nerves (ligaments?), if not used, are not the 
least liable to be so affected; they are impaired, 
then, for the reasons we have stated, more in 
this variety of dislocation than in the others, for 
the whole limb is wasted, both in its bones and 
in its fleshy parts. Such persons, then, when 
they attain their full growth, keep the limb 
raised and flexed, rest the weight of the body 
on the other leg, and support themselves with 
a staff, some with one, and others with two. 

59. In dislocations of the head of the thigh- 
bone forward (they are of rare occurrence), the 
patients cannot extend the leg completely, but 
least of all can they bend it at the groin; they 
are pained, also, if forced to bend the limb at 
the ham. The length of the leg, if compared at 
the heel, is the same as that of the other; but 
the extremity of the foot inclines less to project 
forward. But the whole limb has its natural 
direction, and inclines neither to this side nor 
to that. These cases are particularly attended 
with severe pain, and they are more apt to be 
accompanied with retention of urine at first 
than any of the other dislocations; for the head 
of the thigh-bone is lodged very near to impor- 
tant nerves. And the region of the groin appears 
swelled out and stretched, while that of the na- 
tes is more wrinkled and flabby. The symptoms 
now stated are those which attend this disloca- 
tion of the thigh-bone. 

60. When persons have attained their full 
growth before meeting with this dislocation, 
and when it has not been reduced, upon the 
subsidence of the pain, and when the bone of 
the joint has been accustomed to be rotated in 
the place where it is lodged, these persons can 
walk almost erect without a staff, and with the 
injured leg almost quite straight, as it does not 
admit of easy flexion at the groin and the ham; 
owing, then, to this want of flexion at the groin, 



they keep the limb more straight in walking 
than they do the sound one. And sometimes 
they drag the foot along the ground, as not be- 
ing able to bend the upper part of the limb, and 
they walk with the whole foot on the ground; 
for in walking they rest no less on the heel than 
on the fore part of the foot; and if they could 
take great steps, they would rest entirely on the 
heel in walking; for persons whose limbs are 
sound, the greater the steps they take in walk- 
ing, rest so much the more on the heel, while 
they are putting down the one foot and raising 
the opposite. In this form of dislocation, per- 
sons rest their weight more on the heel than on 
the anterior part of the foot, for the fore part 
of the foot cannot be bent forward equally well 
when the rest of the limb is extended as when 
it is in a state of flexion; neither, again, can the 
foot bearched to the same degree when the limb 
is bent as when it is extended. The natural state 
of matters is such as has been now described; 
and in an unreduced dislocation, persons walk 
in the manner described, for the reasons which 
have been stated. The limb, moreover, is less 
fleshy than the other, at the nates, the calf of 
the leg, and the whole of its posterior part. 
When this dislocation occurs in infancy, and is 
not reduced, or when it is congenital, in these 
cases the bone of the thigh is more atrophied 
than those of the leg and foot; but the atrophy 
of the thigh-bone is least of all in this form of 
dislocation. The fleshy parts, however, are ev- 
erywhere attenuated, more especially behind, 
as has been stated above. If properly trained, 
such persons, when they grow up, can use the 
limb, which is only a little shorter than the other, 
and yet they support themselves on a staff at the 
affected side. For, not being able to use proper- 
ly the ball of the foot without the heel, nor to 
put it down as some can in the other varieties 
of dislocation (the cause of which has been just 
now stated), on this account they require a 
staff. But those who are neglected, and are not 
in the practice of putting their foot to the ground , 
but keep the limb up, have the bones more atro- 
phied than those who use the limb; and, at the 
articulations, the limb is more maimed in the 
direct line than in the other forms of disloca- 
tion. 

61. In a word, luxations and subluxations 
take place in different degrees, being some- 
times greater and sometimes less; and those 
cases in which the bone has slipped or been dis- 
placed to a much greater extent, are in general 
more difficult to rectify than otherwise; and if 
not reduced, such cases have greater and more 



Hippocrates 



striking impairment and lesion of the bones, 
fleshy parts, and attitudes; but when the bone 
has slipped, or been displaced to a less extent, 
it is easier to reduce such cases than the other; 
and if the attempts at reduction have failed, or 
have been neglected, the impairment in such 
cases is less, and proves less injurious than in 
the cases just mentioned. The other joints pre- 
sent great differences as to the extent of the dis- 
placements which they are subject to. But the 
heads of the femur and humerus are very sim- 
ilar to one another as to their dislocations. For 
the heads of the bones are rounded and smooth, 
and tne sockets which receive the heads are also 
circular, and adapted to the heads; they do not 
admit then of being dislocated in any interme- 
diate degree, but, from their rounded shape, the 
bones slip either outward or inward. In the case 
we arc now treating of, then, there is either a 
complete dislocation or none at all, and yet 
these bones admit of being displaced to a great- 
er or less extent; and the thigh is more subject 
to these differences than the arm. 

62. Wherefore, then, some of these congeni- 
tal displacements, if to a small extent, may be 
reduced to their natural condition, and especial- 
ly those at the ankle-joint. Most cases of con- 
genital club-foot are remediable, unless the dec- 
lination be very great, or when the affection oc- 
curs at an advanced period of youth. The best 
plan, then, is to treat such cases at as early a 
period as possible, before the deficiency of the 
bones of the foot is very great, and betore there 
is any great wasting of the flesh of the leg. There 
is more than one variety oi: club-foot, the most 
of them being not complete dislocations, but 
impairments connected with the habitual main- 
tenance of the limb in a certain position. In con- 
ducting the treatment, attention must be paid 
to the following points: to push back and recti- 
fy the bone of the leg at the ankle Irom without 
inward, and to make counter-pressure on the 
bone of the heel in an outward direction, so as 
to bring it into line, in order that the displaced 
bones may meet at the middle and side of the 
foot; and the mass of the toes, with the great 
toe, are to be inclined inward, and retained so; 
and the parts are to be secured, with cerate con- 
taining a full proportion of resin, with com- 
presses, and soft bandages in sufficient quantity, 
but not applied too tight; and the turns of the 
bandages should be in the same direction as the 
rectifying of the foot with the hand, so that the 
foot may appear to incline a little out ward. And 
a sole made of leather not very hard, or of lead, 
is to be bound on, and it is not to be applied to 



the skin but when you are about to make the 
last turns of the bandages. And when it is all 
bandaged, you must attach the end of one of the 
bandages that are used to the bandages applied 
to the inferior part of the foot on the line of the 
little toe; and then this bandage is to be rolled 
upward in what is considered to be a sufficient 
degree, to above the calf of the leg, so that it 
may remain firm when thus arranged. In a 
word, as if moulding a wax model, you must 
bring to their natural position the parts which 
were abnormally displaced and contracted to- 
gether, so rectifying them with your hands, and 
with the bandaging in like manner, as to bring 
them into their position, not by force, but gent- 
ly; and the bandages are to be stitched so as to 
suit the position in which the limb is to be 
placed, for different modes of the deformity re- 
quire different positions. And a small shoe made 
of lead is to be bound on externally to the band- 
aging, having the same shape as the Chian slip- 
pers had. But there is no necessity for it if the 
parts be properly ad justed with the hands, prop- 
erly secured with the bandages, and properly 
disposed of afterward. This, then, is the mode 
of cure, and it neither requires cutting, burn- 
ing, nor any other complex means, for such cases 
yield sooner to treatment than one would be- 
lieve. However, they are to be fairly mastered 
only by time, and not until the body has grown 
up in the natural shape;- when recourse is had 
to a shoe, the most suitable are the buskins, 
which derive their name from being used in 
traveling through mud; for this sort of shoe 
does not yield to the foot, but the foot yields to 
it. A shoe shaped like the Cretan is also suitable. 
63 .In cases ot complete dislocation at the ankle- 
joint, complicated with an external wound, 
whether the displacement be inward or outward, 
you are not to reduce the parts, but let any oth- 
er physician reduce them if he choose.- For this 
you should know for certain, that the patient 
will die if the parts are allowed to remain re- 
duced, and that he will not survive more than 
a few days, for few of them pass the seventh 
day, being cut off by convulsions, and some- 
times the leg and foot are seized with gan- 
grene. It should be well known that such will 
be the results; and it does not appear to me 
that hellebore will do any good, though admin- 
istered the same day, and the draught repeated, 
and yet it is the most likely means, if any such 
there be; but I am of opinion that not even it 
will be of service. But if not reduced, nor any 
attempts at first made to reduce them, most of 
such cases recover. The leg and foot are to be 



On the Articulations 



115 



arranged as the patient wishes, only they must 
not be put in a dependent position, nor moved 
about; and they are to be treated with pitched 
cerate, a few compresses dipped in wine, and 
not very cold, for cold in such cases induces con- 
vulsions; the leaves also of beet, or of colt's foot, 
of any such, when boiled in dark-colored aus- 
tere wine, form a suitable application to the 
wound and the surrounding parts; and the 
wound may further be anointed with cerate in 
a tepid state. But if it be the winter season, the 
part is to be covered with unsecured wool, 
which is to be sprinkled from above with tepid 
wine and oil, but on no account is either band- 
age or compress to be applied; for this should 
be known most especially, that whatever com- 
presses, or is heavy, does mischief in such cases. 
And certain of the dressings used to recent 
wounds are suitable in such cases; and wool 
may be laid upon the sore, and sprinkled with 
wine, and allowed to remain for a considerable 
time; but those dressings for recent wounds 
which only last for a few days, and into which 
resin enters as an ingredient, do not agree with 
them; for the cleansing of the sores is a slow 
process, and the sore has a copious discharge 
for a long time. Certain of these cases it may 
be advantageous to bandage. It ought also to be 
well understood, that the patient must neces- 
sarily be much maimed and deformed, for the 
foot is retracted outward, and the bones which 
have been displaced outward protrude: these 
bones, in fact, not being generally laid bare, un- 
less to a small extent; neither do they exfoliate, 
but they heal by thin and feeble cicatrices, pro- 
vided the patient keeps quiet for a length of 
time; but otherwise there is danger that a small 
ulcer may remain incurable. And yet in the case 
we are treating of, those who are thus treated 
are saved; whereas, when the parts are reduced 
and allowed to remain in place, the patients die. 
64. The same rule applies to dislocations at 
the wrist, attended with a wound and projec- 
tion of the bone, whether the bones of the arm 
be displaced inward or out ward. For this should 
be well understood, that the patient will die in 
the course of a few days, by the same mode of 
death as formerly described, if the bone be re- 
duced, and allowed to remain so. But in those 
cases in which they are not reduced, nor any at- 
tempt made to reduce them, the patients, for 
the most part, recover; and the same mode of 
treatment as has been described will be appli- 
cable; but the deformity and impediment of the 
limb must necessarily be great, and the fingers 
of the hand will be weak and useless; for if the 



bones have slipped inward, they cannot bend 
the fingers, or if outward, they cannot extend 
them. 

65. When the os tibiae, having made a wound 
at the knee, has protruded through the skin, 
whether the dislocation be outward or inward, 
in such a case, if the bone be reduced, death 
will be even more speedy than in the other cases, 
although speedy also in them. But the only 
hope of recovery is if you treat them without re- 
duction. These cases are more dangerous than 
the others, as being so much higher up, as be- 
ing so much stronger joints, and displaced from 
bones which are so much stronger. But if the os 
femoris form a wound at the knee, and slip 
through it, provided it be reduced and left so, 
it will occasion a still more violent and speedy 
death than in the cases formerly described; but 
if not reduced, it will be much more dangerous 
than those cases mentioned before, and yet this 
is the only hope of recovery. 

66. The same rule applies to the elbow-joint, 
and with regard to the bones of the fore-arm and 
arm. For when these bones protrude through a 
wound which they have made in the skin, all 
cases in which they are reduced prove fatal; but 
if not reduced, there is a chance of recovery; 
but to those that survive there is certain impedi- 
ment. And if in any instance the bones of the 
upper articulations (shoulder-joint?), should 
be dislocated, and project through a wound 
which they have made in the skin, these, if re- 
duced, are followed by more speedy death; and 
if not reduced, they are more dangerous than 
the others. But the mode of treatment which 
appears to me most suitable has been already de- 
scribed. 

67. When the joints of the toes or hands are 
dislocated, and the bones protrude through a 
wound which they have made, and when there 
is no fracture of the bone, but merely displace- 
ment of the joint, in these cases, if the reduc- 
tion be made and allowed to remain, there is 
some danger of spasms (tetanus?) if not prop- 
erly treated, and yet it may be worth while to 
reduce them, having warned the patient before- 
hand that much caution and care will be re- 
quired. The easiest, the most efficient method, 
and the one most conformable to art, is that by 
the lever, as formerly described when treating 
of bones which have been fractured and pro- 
truded; then the patient must be as quiet as pos- 
sible, lie in a recumbent position, and observe 
a restricted regimen. And it will be better also 
that he should get some gentle emetics. The sore 
is to be treated with dressings for fresh wounds, 



n6 Hippocrates 

which permit of affusions, or with the leaves of 
camomile, or with the applications for fractured 
bones of the head, but nothing very cold must 
be applied. The first (most distant?) joints arc 
least dangerous, but those still higher, are more 
so. Reduction should be made the same day, or 
the next, but by no means on the third or fourth, 
for it is on the fourth day that exacerbations 
especially attack. In those cases, then, where im- 
mediate reduction cannot be accomplished, we 
must wait until after the aforesaid days; for 
whatever you reduce within ten days, may be 
expected to induce spasm. But if the spasm su- 
pervene on its being reduced, the joint should 
be quickly displaced, and bathed frequently 
with warm water, and the whole body should 
be kept in a warm, soft, and easy condition, and 
more especially about the joints, for the whole 
body should rather be in a bent than in an ex- 
tended state. Moreover, it is to be expected, that 
the articular extremities of the bones of the fin- 
gers will exfoliate, for this generally happens, 
if even the least degree of inflammation take 
place, so that if it were not that the physician 
would be exposed to censure, owing to the ig- 
norance of the common people, no reduction 
should be made at all. The reduction of the bones 
of joints which have protruded through the skin, 
is attended with the dangers which have been 
described. 

68. When the articular bones of the fingers 
are fairly chopped off, these cases are mostly un- 
attended with danger, unless dehquium come 
on in consequence of the injury, and ordinary 
treatment will be sufficient to such sores. But 
when resection is made, not at the articulations, 
but at some other point in the bones, these cases 
also are free from danger, and are still more 
easily cured than the others; and the fractured 
bones of the fingers which protrude otherwise 
than at the joint admit of reduction without 
danger. Complete resections of bones at the 
joints, whether the foot, the hand, the leg, the 
ankle, the forearm, the wrist, for the most part, 
are not unattended with danger, unless one be 
cut off at once by deliquium animi, or if con- 
tinual fever supervene on the fourth day. 

69. With regard to the sphacelus of fleshy 
parts, it takes place in wounds where there arc 
large blood-vessels, which have been strongly 
compressed, and in fractures of bones which 
have been bound too tight, and in other cases of 
immoderate constriction, when the parts which 
have been strangulated generally drop off; and 
the most of such patients recover, even when a 
portion of the thigh comes away, or of the arm, 



both bones and flesh, but less so in this case; and 
when the fore-arm and leg drop off, the patients 
readily recover. In cases then, of fracture of the 
bones, when strangulation and blackening of 
the parts take place at first, the separation of 
the dead and living parts quickly occurs, and 
the parts speedily drop off, as the bones have 
already given way; but when the blackening 
(mortification) takes place while the bones are 
entire, the fleshy parts, in this case, also quickly 
die; but the bones are slow in separating at 
the boundary of the blackening, and where the 
bones are laid bare. Those parts of the body 
which are below the boundaries of the blacken- 
ing are to be removed at the joint, as soon as 
they are fairly dead and have lost their sensi- 
bility; care being taken not to wound any liv- 
ing part; for if the part which is cut off give 
pain, and if it should prove not to be quite dead, 
there is great danger lest the patient may swoon 
away from the pain, and such swoonings often 
are immediately fatal. I have known the thigh- 
bones, when denuded in this manner, drop off 
on the eightieth day; but in the case of this pa- 
tient, the parts below were separated at the knee 
on the twentieth day, and, as I thought, too early, 
for it appeared to me that this should be done 
more guardedly. In a case which I had of such 
blackening in the leg, the bones of the leg, as 
far as they were denuded, separated at its mid- 
dle on the sixtieth day. But the separation of de- 
nuded bones is quicker or slower, according to 
the mode of treatment; something, too, depends 
upon whether the compression be stronger or 
weaker, and whether the nerves, flesh, arteries, 
and veins are quicker or slower in becoming 
blackened and in dying; since, when the parts 
arc not strongly compressed, the separation is 
more superficial, and does not go the length of 
laying the bones bare, and in some cases it is 
still more superficial, so as not even to expose 
the nerves. For the reasons now stated, it is im- 
possible to define accurately the time at which 
each of these cases will terminate. The treat- 
ment of such cases, however, is to be readily un- 
dertaken, for they are more formidable to look 
at than to treat; and a mild treatment is suffi- 
cient in all such cases, for they come to a crisis 
of themselves; only the diet must be attended 
to, so that it may be as little calculated to create 
fever as possible, and the body is to be placed 
in the proper positions: these are, neither raised 
very high up, nor inclined much downward, 
but rather upward, until the separation be com- 
pleted; for at that time there is most danger of 
hemorrhage; on this account, wounds should 



On the Articulations 



not be laid in a declining position, but the con- 
trary. But after a while, and when the sores have 
become clean, the same positions will no longer 
be appropriate; but a straight position, and one 
inclining down ward, may be proper; and in the 
course of time, in some of these cases, abscesses 
form, and require bandages. One may also ex- 
pect that such patients will be attacked with 
dysentery; for dysentery usually supervenes in 
cases of mortification and of hemorrhage from 
wounds; it comes on generally when the black- 
ening and hemorrhage have arrived at a crisis, 
and is profuse and intense, but does not last 
many days; neither is it of a fatal nature, for 
such patients do not usually lose their appetite, 
nor is it proper to put them on a restricted diet. 
70. Dislocation inward at the hip-joint is to 
be reduced in the following manner: (it is a 
good, proper, and natural mode of reduction, 
and has something of display in it, if any one 
takes delight in such ostentatious modes of pro- 
cedure). The patient is to be suspended by the 
feet from a cross-beam with a strong, soft, and 
broad cord; the feet are to be about four inches 
or less from one another; and a broad and soft 
leather collar connected with the cross-beam is 
to be put on above the knees; and the affected 
leg should be so extended as to be two inches 
longer than the other; the head should be about 
two cubits from the ground, or a little more or 
less; and the arms should be stretched along 
the sides, and bound with something soft; all 
these preparations should be made while he is 
lying on his back, so that he may be suspended 
for as short a time as possible. But when the pa- 
tient is suspended, a person properly instructed 
and not weak, having introduced his arm be- 
tween his thighs, is to place his fore-arm be- 
tween the perineum and the dislocated head of 
the osfemoris;and then, having joined the other 
hand to the one thus passed through the thighs, 
he is to stand by the side of the suspended pa- 
tient, and suddenly suspend and swing himself 
in the air as perpendicularly as possible. This 
method comprises all the conditions which are 
natural; for the body being suspended by its 
weight, produces extension, and the person sus- 
pended from him, along with the extension, 
forces the head of the thigh-bone to rise up a- 
bove the acetabulum; and at the same time he 
uses the bone of the fore-arm as a lever, and 
forces the os femoris to slip into its old seat. The 
cords should be properly prepared, and care 
should be taken that the person suspended a- 
long with the patient have a sufficiently strong 
hold. 



71. Wherefore, as formerly stated, men's con- 
stitutions differ much from one another as to 
the facility or difficulty with which dislocations 
are reduced; and the cause of this was also stated 
formerly in treating of the shoulder. In some 
the thigh is reduced with no preparation, with 
slight extension, directed by the hands, and with 
slight movement; and in some the reduction is 
effected by bending the limb at the joint, and 
making rotation. But much more frequently it 
does not yield to any ordinary apparatus, and 
therefore one should be acquainted with the 
most powerful means which can be applied in 
each case, and use whatever may be judged most 
proper under all circumstances. The modes of 
extension have been described in the former 
parts of the work, so that one may make use of 
whatever may happen to be at hand. For, ex- 
tension and counter-extension are to be made 
in the direction of the limb and the body; and 
if this be properly effected, the head of the thigh- 
bone will be raised above its ancient seat; and 
if thus raised, it will not be easy to prevent it 
from settling in its place, so that any ordinary 
impulse with the lever and adjustment will be 
quite sufficient; but some apply insufficient ex- 
tension, and hence the reduction gives much 
trouble. The bands then should be fastened, not 
only at the foot, but also above the knee, so that 
the force of the extension may not be expended 
on the knee-joint more than upon the hip-joint. 
The extension in the direction of the foot is to 
be thus contrived. But the counter-extension is 
not only to be managed by means of something 
carried round the chest and armpits, but also 
by a long, double, strong, and supple thong ap- 
plied to the perineum, and carried behind along 
the spine, and in front along the collar-bone and 
fixed to the point from which counter-extension 
is made; and then force is to be so applied, by 
means ot this extension and counter-extension, 
that the thong at the perineum may not pass 
over the head of the thigh-bone, but between it 
and the perineum; and during the extension 
one should strike the head of the femur with 
the fist, so as to drive it outward. And when the 
patient is raised up by the stretching, you should 
pass a hand through (between the legs?) and 
grasp it with the other hand, so as at the same 
time to make extension, and force the dislocated 
limb outward; while some other person sitting 
by the knee quietly directs it inward. 

72. It has been formerly stated by us that it 
will be of importance for any person who prac- 
tices medicine in a populous city to get prepared 
a quadrangular board, about six cubits or a little 



n8 



Hippocrates 



more in length, and about two cubits in breadth; 
a fathom will be sufficient thickness for it; and 
then along it from the one end to the other, an 
excavation must be made, so that the working 
of the levers may not be higher than is proper; 
then at both sides we are to raise short, strong, 
and strongly-fixed posts, having axles; and in 
the middle of the bench five or six long grooves 
are to be scooped out about four inches distant 
from one another, three inches will be a suffi- 
cient breadth for them, and the depth in like 
manner; and although the number of grooves 
I have mentioned will be sufficient, there is noth- 
ing to prevent their being made all over the 
bench. And the bench should have in its middle 
a pretty deep hole, of a square shape, and of a- 
boutthree inches in size; and into this hole, when 
judged necessary, is to be adjusted a correspond- 
ing piece of wood, rounded above, which, at the 
proper time, is to be adjusted between the per- 
ineum and the head of the thigh-bone. This up- 
right piece of wood prevents the body from yield- 
ing to the force dragging downward by the feet; 
for sometimes this piece of wood serves the pur- 
pose of counter-extension upward; and some- 
times, too, when extension and counter-exten- 
sion are made, this piece of wood, if susceptible 
of some motion to this side or that, will serve 
the purpose of a lever for pushing the head of 
the thigh-bone outward. It is on this account 
that several grooves are scooped out on the bench, 
so that this piece of wood, being erected at the 
one which answers, may act as a lever, either on 
the sides of the articular heads of bones, or may 
make pressure direct on the heads along with 
the extension, according as it may suit to push 
inward or outward with the lever; and the lever 
may be either of a round or broad form, as may 
be judged proper; for sometimes the one form 
and sometimes the other suits with the articula- 
tion. Thismode ot applyingthe leveralongwith 
extension is applicable in the reduction of all 
dislocations ot the thigh. In the case now on 
hand, a round lever is proper; but in dislocations 
outward a flat lever will be the suitable one. By 
means of such machines and of such powers, it 
appears to me that we need never fail in reduc- 
ing any dislocation at a joint. 

73. And one might find out other modes of 
reduction for this joint. If the large bench were 
to have raised on it two posts about a foot (in 
diameter?), and of a suitable height, on each 
side near its middle, and if a transverse piece 
of wood like the step of a ladder, were inserted 
in the posts, then if the sound leg were carried 
through between the posts, and the injured limb 



were brought over the transverse piece of wood, 
which should be exactly adapted in height to 
the joint which is dislocated (and it is an easy 
matter so to adjust it, for the step of the ladder 
should be made a little higher than required, 
and a convenient robe, folded several times, is 
to be laid below the patient's body), then apiece 
of wood, of suitable breadth and length, is to be 
laid below the limb, and it should reach from 
the ankle to beyond the head of the thigh-bone, 
and should be bound moderately tight to the 
limb. Then the limb being extended, either by 
means of the pestle-like piece of wood (former- 
ly described), or by any of the other methods of 
extension, the limb which is carried over the 
step with the piece of wood attached to it, is to 
be forced downward, while somebody grasps 
the patient above the hip-joint. In this manner 
the extension will carry the head of the thigh- 
bone above the acetabulum, while the lever pow- 
er that is exercised will push the head of the 
thigh-bone into its natural seat. All the above- 
mentioned powers are strong, and more than 
sufficient to rectify the accident, if properly and 
skillfully applied. For, as formerly stated, in 
most cases reduction may be effected by much 
weaker extension, and an inferior apparatus. 

74. If the head of the bone slip outward, ex- 
tension and counter-extension must be made as 
described, or in a similar manner. But along 
with the extension a broad lever is to be used to 
force the bone from without inward, the lever 
being placed at the nates or a little farther up, 
and some person is to steady the patient's body, 
so that it may not yield, either by grasping him 
atthe buttockswith hishands, or this may be ef- 
fected by means of another similar lever, ad- 
justed to one of the grooves, while the patient 
has something laid below him, and he is secured, 
and the dislocated thigh is to be turned gently 
from within outward at the knee. Suspension 
will not answer in this form of dislocation, for, 
in this instance, the arm of the person suspend- 
ed from him, would push the head of the thigh- 
bone from the acetabulum. But one might use 
the piece of wood placed below him as a lever, 
in such a manner as might suit with this mode 
of dislocation; it must work from without. But 
what use is there for more words? For if the ex- 
tension be well and properly done, and if the 
lever be properly used, what dislocation of the 
joint could occur, that might not be thus re- 
duced ? 

75. In dislocation of the thigh, backward, ex- 
tension and counter-extension should be made 
as has been described; and having laid on the 



On the Articulations / 



119 



bench a cloth which has been folded several 
times, so that the patient may lie soft, he is to be 
laid on his face, and extension thus made, and, 
along with the extension, pressure is to be made 
with a board, as in the case of humpback, the 
board being placed on the region of the nates, 
and rather below than above the hip-joint; and 
the hole made in the wall for the board should 
not be direct over, but should be inclined a little 
downward, toward the feet. This mode of re- 
duction is particularly appropriate to this vari- 
ety of dislocation, and at the same time is very 
strong. But perhaps, instead of the board, it 
might be sufficient to have a person sitting (on 
the seat of luxation ? ) , or pressing with his hands, 
or with his foot, and suddenly raising himself 
up, along with the extension. None of the oth- 
er aforementioned modes of reduction are natu- 
ral in this form of dislocation. 

76. In dislocation forward, the same mode of 
extension should be made; but a person who 
has very strong hands, and is well trained, should 
place the palm of the one hand on the groin, 
and taking hold of this hand with the other, is 
at the same time to push the dislocated part 
downward, and at the same time to the fore 
part of the knee. This method of reduction is 
most especially conformable to this mode of dis- 
location. And the mode of suspension is also not 
far removed from being natural, but the person 
suspended should be well trained, so that his 
arm may not act as a lever upon the joint, but 
that the force of the suspension may act about 
the middle of the perineum, and at the os sac- 
rum. 

77. Reduction by the bladder is also celebrat- 
ed in dislocations at this joint, and I have seen 
certain persons who, from ignorance, attempted 
to reduce both dislocations outward and back- 
ward therewith, not knowing that they were 
rather displacing than replacing the parts; it is 
clear, however, that he who first invented this 
method intended it for dislocation inward. It is 
proper, then, to know how the bladder should 
be used, if it is to be used, and it should be un- 
derstood that many other methods are more 
powerful than it. The bladder should be placed 
between the thighs uninflated, so that it may be 
carried as far up the perineum as possible, and 
the thighs beginning at the patella are to be 
bound together with a swathe, as far up as the 
middle of the thigh, and then a brass pipe is to 
be introduced into one of the loose feet of the 
bladder, and air forced into it, the patient is to 
lie on his side with the injured limb uppermost. 
This, then, is the preparation; some, however, 



do the thing worse than as I have described, for 
they do not bind the thighs together to any ex- 
tent, but only at the knees, neither do they make 
extension, whereas extension should be made, 
and yet some people by having the good fortune 
to meet with a favorable case, have succeeded in 
making reduction. But it is not a convenient 
method of applying force, for the bladder, when 
inflated, does not present its most prominent 
part to the articular extremity of the femur, 
which is the place that ought to be more especi- 
ally pressed outward, but its middle, which prob- 
ably corresponds with the middle of the thigh, 
or still lower down, for the thighs are naturally 
curved, being fleshy, and in contact above, and 
becoming smaller downward, so that the natu- 
ral configuration of the parts forces the blad- 
der from the most proper place. And if a small 
bladder be introduced, its power will be small, 
and unable to overcome the resistance of the 
articular bone. But if the bladder must be used, 
the thighs are to be bound together to a consid- 
erable extent, and the bladder is to be inflated 
along with the extension of the body, and in this 
method of reduction both legs are to be bound 
together at their extremity. 

78. The prime object of the physician in the 
whole art of medicine should be to cure that 
which is diseased; and if this can be accom- 
plished in various ways, the least troublesome 
should be selected; for this is more becoming a 
good man, and one well skilled in the art, who 
does not covet popular coin of base alloy. With 
regard to the subject now on hand, the follow- 
ing are domestic means of making extension of 
the body, so that it is easy to choose from among 
the things at hand: In the first place, when soft 
and supple thongs are not at hand for ligatures, 
either iron chains, or cords, or cables of ships, 
are to be wrapped round with scarfs or pieces 
of woolen rags, especially at the parts of them 
which are to be applied, and in this state they 
are to be used as bands. In the second place, the 
patient is to be comfortably laid on the strong- 
est and largest couch that is at hand, and the 
feet of the couch, either those at the (patient's?} 
head, or those at the feet, are to be fastened to 
the threshold, either within or without, as is 
most suitable; and a square piece of wood is to 
be laid across, and extending from the one foot 
to the other; and if this piece of wood be slen- 
der, it should be bound to the feet of the couch, 
but, if it be thick, there will be no necessity for 
this; then the heads of the ligatures, both of 
those at the head and those at the feet, are to be 
fastened to a pestle, or some such piece of wood, 



i2.o Hippocrates 

at either end; the ligatures should run alongthe 
line of the body, or be a little elevated above it, 
and it should be stretched proportionally to the 
pestles, so that, standing erect, the one may be 
fastened to the threshold, and the other to the 
transverse piece of wood. Extension is then to 
be made by bending back the ends of the pes- 
tles. A ladder, having strong steps, if laid below 
the bed, will serve the purpose of the threshold 
and the piece of wood laid along (the foot of 
the couch?), as the pestles can be fastened to the 
steps at either end, and when drawn back they 
thus make extension of the ligatures. Disloca- 
tion, inward or forward, may be reduced in the 
following manner: a ladder is to be fastened in 
the ground, and the man is to be seated upon it, 
and then the sound leg is to be gently stretched 
along and bound to it, wherever it is found con- 
venient; and water is to be poured into an earth- 
en vessel, or stones put into a hamper and slung 
from the injured leg, so as to effect the reduc- 
tion. Another mode of reduction: a cross-beam 
is to be fastened between two pillars of moder- 
ate height; and at one part of the cross-beam 
there should be a protuberance proportionate to 
the size of the nates; and having bound a cover- 
let round the patient's breast, he is to be seated 
on the protuberant part of the cross-beam, and 
afterward the breast is to be fastened to the pil- 
lar by some broad ligature; then some one is 
to hold the sound leg so that he may not fall 
oil, and from the injured limb is to be sus- 
pended some convenient weight, as formerly 
described. 

79. It should be particularly known that the 
union of all bones is, for the most part, by a 
head and socket (cotyle); in some of these the 
place (socket?) is cotyloid and oblong, and in 
some the socket is glenoid (shallow?). In all 
dislocations reduction is to be effected, if pos- 
sible, immediately, while still warm, but other- 
wise, as quickly as it can be done; for reduction 
will be a much easier and quicker process to the 
operator, and a much less painful one to the pa- 
tient, if eflected before swelling comes on. But 
all the joints when about to be reduced should 
be first softened, and gently moved about; for, 
thus they are more easily reduced. And, in all 
cases of reduction at joints, the patient must be 
put on a spare diet, but more especially in the 
case of the greatest joints, and those most dif- 
ficult to reduce, and less so in those which arc 
very small and easily reduced. 

80. If any joint of the fingers is dislocated, 
whether the first, second, or the third, the same 
method of reduction is to be applied, but the 



largest joints are the most difficult to reduce. 
There are four modes of displacement either 
up ward, down ward, or to either side; most com- 
monly upward, and most rarely laterally, and 
in consequence of violent motion. On both sides 
of its articular cavity there is a sort of raised 
border. When the dislocation is upward or 
down ward, owing to the articular cavity having 
smoother edges there than at the sides, if the 
joint of it be dislocated, it is more easily re- 
duced. This is the mode of reduction: The 
end of the finger is to be wrapped round with a 
fillet, or something such, that, when you lay 
hold of it and make extension, it will not slip; 
and when this is done, some person is to grasp 
the arm at the wrist, and another is to take hold 
of the finger which is wrapped in the fillet, and 
then each is to make considerable extension to- 
ward himself, and at the same time the project- 
ing bone is to be pushed into its place. But, if 
the dislocation be lateral, the same mode of re- 
duction is to be used; but when you think that 
the extremity of the bone has cleared the rim, 
at the same time that extension is made, the 
bone is to be pushed direct into its place, while 
another person on the other side of the finger is 
to take care and make counter-pressure, so that 
it may not again slip out there. The twisted 
nooses formed from palm-shoots are convenient 
tor effecting reduction, if you will make exten- 
sion and counter-extension by holding the twist- 
ed string in the one hand and the wrist in the 
other. When reduced, you must bind the part 
as quickly as possible with bandages; these are 
to be very slender and waxed with cerate, nei- 
ther very soft nor very hard, but of middle con- 
sistence; for that which is hard drops off from 
the finger, while that which is soft and liquid 
is melted and lost by the increased heat of the 
finger. The bandage is to be loosed on the third 
or fourth day; but on the whole, if inflamed, it 
is to be the more frequently loosed, and if oth- 
erwise, more rarely; this I say respecting all the 
joints. The articulation of a finger is restored 
in fourteen days. The treatment of the fingers 
and of the toes is the same. 

81. After all reductions of joints the patient 
should be confined to a restricted diet and ab- 
stinence until the seventh day; and if there be 
inflammation, the bandages are to be the more 
frequently loosed, but otherwise, less frequent- 
ly, and the pained joint is to be kept constantly 
in a state of rest, and is to be laid in the most 
convenient position possible. 

82. Accidents at the knee are more mild than 
at the elbow, from its being more compact, regu- 



Instruments of Reduction 



lar, and elegant in its construction; and, there- 
fore, it is more readily dislocated and reduced. 
It is most frequently dislocated inward, but al- 
so outward and back ward. The modes of reduc- 
tion are these: by flexion at the knee, or by sud- 
den calcitration, or having rolled a swathe into 
a ball, and fixed it in the ham, the patient's body 
is to be suddenly dropped on its bended knees. 
Dislocation backward, also, as in the case of the 
elbow, may be reduced by moderate extension, 
and to either side, either by flexion or calcitra- 
tion, but also by moderate extension. The ad- 
justment is the same in all cases. In dislocations 
backward which are not reduced, the patient 
cannot bend the joint, but neither can he, to any 
great extent, in the other varieties; the thigh 
and leg are wasted in front; but if inward 
the patients become bow-legged, and the ex- 
ternal parts are wasted; but if outward they 
become more bandy-legged, but the impedi- 
ment is less, for the body is supported on the 
larger of the bones, and the inner parts are 
wasted. When these accidents happen at birth 
or during adolescence, they follow the rule 
formerly stated. 

83. Dislocations at the ankle-joints require 
strong extension, either with the hands or some 
such means; and adjustment, which at the same 
time effects both purposes, as is common in all 
cases. 

84. Injuries of the foot are to be remedied like 
those of the hand. 

85. The bones connected with the leg, and 
which are dislocated, either at birth or during 
adolescence, follow the same course as those in 
the hand. 

86. When persons jumping from a height 
pitch on the heel, so as to occasion separation 
(diastasis) of the bones, ecchymosis of the veins, 
and contusion of the nerves; when these symp- 
toms are very violent there is danger of sphace- 
lus, and that the case may give trouble during 
life, for the bones are so constructed as to slip 
from one another, and the nerves communicate 



III 

together. And, indeed, in cases of fracture, ci- 
ther from an injury in the leg or thigh, or in 
paralysis of the nerves (tendons?) connected 
with these parts, or from neglect during con- 
finement to bed, when the heel gets blackened 
the most serious consequences result therefrom. 
Sometimes, in addition to the sphacelus, there 
come on acute fevers accompanied with hiccup, 
aberration of intellect, and speedy death, with 
lividities of the large blood-vessels. With re- 
gard to the symptoms attending exacerbations, 
if the ecchymosed and blackened parts and those 
around be somewhat hard and red, and if a- 
long with the hardness there be lividity, morti- 
fication is to be apprehended; but if the parts be 
slightly livid, or even very livid, and the swell- 
ing diffused, or if greenish and soft, these ap- 
pearances, in such cases, are all favorable. The 
treatment, if no fever be present, consists in the 
administration of hellebore, but otherwise it is 
not to be given, but OAry^/y^y (decoction of hon- 
eycombs and vinegar) is to be given for drink, 
if required. Bandaging as in the other articu- 
lations: above all, more especially in contusions, 
the bandages should be numerous and softer 
than usual, but the compression should be less; 
most turns should be made around the heel. 
Position, like the bandaging, should be so regu- 
lated as not to determine to the heel. Splints 
are not to be used. 

87. When the foot is dislocated, either alone 
or along with its epiphysis, the displacement is, 
for the most part, to the inside. If not reduced, 
in the course of time, the hip, the thigh, and 
the side of the leg opposite the dislocation, be- 
come atrophied. Reduction is the same as in the 
wrist, but the extension requires to be very pow- 
erful. Treatment, agreeably to the general rule 
for joints. Exacerbations do occur, but less fre- 
quently than in dislocations at the wrist, pro- 
vided the parts get rest. While they remain at 
rest the diet should be restricted. Those which 
occur at birth, or during adolescence, follow the 
rule formerly stated. 



Instruments of Reduction 



WITH regard to the construction of bones, 
the bones and joints of the fingers are simple, 
the bones of the hand and foot are numerous, 
and articulated in various ways; the uppermost 
are the largest; the heel consists of one bone 
which is seen to project outward, and the back 
tendons are attached to it. The leg consists of 



two bones, united together above and below, 
but slightly separated in the middle; the ex- 
ternal bone (fibula), where it comes into prox- 
imity with the little toe, is but slightly smaller 
than the other, more so where they are sepa- 
rated, and at the knee, the outer hamstring 
arises from it; these bones have a common 



111 Hippocrates 

cpiphysis below, with which the foot is moved, 
and another epiphysis above, 1 in which is moved 
the articular extremity of the femur, which is 
simple and light in proportion to its length, in 
the form of a condyle, and having the patella 
(connected with it?), the femur itself bends 
outward and forward; its head is a round epiph- 
ysis which gives origin to ligament inserted in 
the acetabulum of the hip-joint. This bone is 
articulated somewhat obliquely, but less so than 
the humerus.The ischium is united to the great 
vertebra contiguous to the os sacrum by a car- 
tilaginous ligament. The spine, from the os sac- 
rum to the great vertebra, is curved backward; 
in this quarter are situated the bladder, the 
organs of generation, and the inclined portion 
of the rectum; from this to the diaphragm it 
proceeds in a straight line inclining forward, 
and the psoae are situated there; from this point, 
to the great vertebra above the tops of the shoul- 
ders, it rises in a line that is curved backward, 
and the curvature appears greater than it is in 
reality, for the posterior processes of the spine 
are there highest; the articulation of the neck 
inclines forward. The vertebra: on the inside 
are regularly placed upon one another, but be- 
hind they are connected by a cartilaginous liga- 
ment; they are articulated in the form of synar- 
throsis at the back part of the spinal marrow; 
behind they have a sharp process having a car- 
tilaginous epiphysis, whence proceeds the roots 
of nerves running downward, as also muscles 
extending from the neck to the loins, and fill- 
ing the space between the ribs and the spine. 
The ribs are connected to all the intervertebral 
spaces on the inside, from the neck to the lum- 
bar region, by a small ligament, and before to 
the sternum, their extremities being spongy and 
soft; their form is the most arched in man of 
all animals; for in this part, man is, of all ani- 
mals, the narrowest in proportion to his bulk. 
The ribs are united to each vertebra by a small 
ligament at the place from which the short and 
broad lateral processes (transverse processes?) 
arise. The sternum is one continuous bone, hav- 
ing lateral pits for the insertion of the ribs; it 
is of a spongy and cartilaginous structure. The 
clavicles are rounded in front, having some 
slight movements at the sternum, but more free 
at the acromion. The acromion, in man, arises 
from the scapular differently from most other 
animals. The scapula is cartilaginous toward 
the spine, and spongy elsewhere, having an ir- 
regular figure externally; its neck and articular 

1 Epiphysis means a close union of the two 
bones by means of a ligament. 



cavity cartilaginous; it does not interfere with 
the movements of the ribs, and is free of all con- 
nection with the other bones, except the hu- 
merus. The head of the humerus is articulated 
with its (glcnoid?) cavity, by means of a small 
ligament, and it consists of a rounded epiphysis 
composed of spongy cartilage, the humerus it- 
self is bent outward and forward, and it is 
articulated with its (glenoid?) cavity by its 
side, and not in a straight line. At the elbow it 
is broad, and has condyles and cavities, and is 
of a solid consistence; behind it is a cavity in 
which the coronoid process (olecranon?) of the 
ulna is lodged, when the arm is extended; here, 
too, is inserted the benumbling nerve, which 
arises from between the two bones of the fore- 
arm at their junction, and terminates there. 

2. When the nose is fractured, the parts should 
be modeled instantly, if possible. If the fracture 
be in its cartilaginous part, introduce into the 
nostrils a tent formed of caddis, inclosed in the 
outer skin of a Carthaginian hide, or anything 
else which does not irritate; the skin is to be 
glued to the parts displaced, which are to be 
thus rectified. Bandaging in this case does mis- 
chief. The treatment is to consist of flour with 
manna, or of sulphur with cerate. You will im- 
mediately adjust the fragments, and afterward 
retain them in place with your fingers intro- 
duced into the nostrils, and turning the parts 
into place; then the Carthaginian skin is to be 
used.Callius forms even when there is a wound; 
and the same things are to be done, even when 
there is to be exfoliation of the bones, for this is 
not of a serious nature. 

3. In fractures of the ears, neither bandages 
nor cataplasms should be used; or, if any band- 
age be used, it should be put on very tight; the 
cerate and sulphur should be applied to ag- 
glutinate the bandages. When matter forms in 
the cars, it is found to be more deeply seated 
than might be supposed, for all parts that are 
pulpy, and consist of juicy flesh, prove decep- 
tious in such a case. But no harm will result 
from making an opening, for the parts are lean, 
watery, and full of mucus. No mention is here 
made of the places and circumstances which 
render it fatal to make an opening. The cure is 
soonest effected by transfixing the car with a 
cautery; but the ear is maimed and diminished 
in size, if burned across. If opened, one of the 
gentle medicines for flesh wounds should be 
used as a dressing. 

4. The jaw-bone is often slightly displaced 
(subluxated?), and is restored again; it is dis- 
located but rarely, especially in gaping; in fact, 



Instruments of Reduction 



1x3 



the bone is never dislocated unless it slips while 
the mouth is opened wide. It slips, however, the 
more readily from its ligaments being oblique, 
supple, and of a yielding nature. The symptoms 
are: the lower jaw protrudes, it is distorted to 
the side opposite the dislocation, and the pa- 
tient cannot shut his mouth; when both sides 
are dislocated, the jaw projects more, the mouth 
can be less shut, but there is no distortion; this 
is shown by the rows of the teeth in the upper 
and lower jaw corresponding with one another. 
If, then, both sides be dislocated, and not im- 
mediately reduced, the patient for the most part 
dies on the tenth day, with symptoms of con- 
tinued fever, stupor, and coma, for the muscles 
there induce such effects; there is disorder of 
the bowels attended with scanty and unmixed 
dejection; and the vomitings, if any, are of the 
same character. The other variety is less trou- 
blesome. The method of reduction is the same 
in both: The patient being laid down or seated, 
the physician is to take hold of his head, and 
grasping both sides of the jaw-bone with both 
hands, within and without, he must perform 
three manoeuvres at once, rectify the position 
of the jaw, push it backward, and shut the mouth. 
The treatment should consist of soothing ap- 
plications, position, and applying a suitable 
bandage to support the jaw-bone, so as to co- 
operate with the reduction. 

5. The bone of the shoulder is dislocated 
downward. I have never heard of any other 
mode. The parts put on the appearance of dis- 
location forward, when the flesh about the joint 
is wasted during consumption, as also seems to 
be the case with cattle when in a state of lean- 
ness after winter. Those persons are most liable 
to dislocations who are thin, slender, and have 
humidities about their joints without inflam- 
mation, for it knits the joints. Those who at- 
tempt to reduce and rectify dislocations in 
oxen, commit a blunder, as forgetting that the 
symptoms arise from the manner in which the 
ox uses the limb, and that the appearance is the 
same in a man who is in a similar condition, 
and forgetting also that Homer has said, that 
oxen are most lean at that season. In this dislo- 
cation, then, when not reduced, the patient can- 
not perform any of those acts which others do, 
by raising the arm from the side. I have thus 
stated who are the persons most subject to this 
dislocation, and how they are affected. In con- 
genital dislocations the nearest bones are most 
shortened, as is the case with persons who are 
weasel-armed; the fore-arm less so, and the 
hand still less; the bones above are not affected. 



And the parts (near the seat of the injury) are 
most wasted in flesh; and this happens more es- 
pecially on the side of the arm opposite the dis- 
location, and that during adolescence, yet in a 
somewhat less degree than in congenital cases. 
The deep-seated suppurations occur most fre- 
quently to new-born infants about the joint of 
the shoulder, and these produce the same con- 
sequences as dislocations. In adults, the bones 
are not so diminished in size, and justly, see- 
ing that the others will not increase as in the 
former case; but wasting of the flesh takes 
place, for it is increased, and is diminished every 
day, and at all ages. And attention should be 
paid to the force of habit, and to the symptom 
produced by the tearing away of the acromion, 
whereby a void is left, which makes people sup- 
pose that the humerus is dislocated. The head 
of the humerus is felt in the armpit, and the pa- 
tient cannot raise his arm, nor swing it to this 
side and that, as formerly. The other shoulder 
shows the difference. Modes of reduction: 
The patient himself having placed his fist in 
the arm pit, pushes up the head of the humerus 
with it, and brings the hand forward to the 
breast. Another: Force it backward, so that 
you may turn it round. Another: Apply your 
head to the acromion, and your hands to the 
armpit, separate the head of the humerus (from 
the side?), and push the elbow in the opposite 
direction; or, instead of your knees, another 
person may turn aside the elbow, as formerly 
directed. Or, place the patient on your shoul- 
der, with the shoulder in his armpit. Or, with 
the heel, something being introduced to fill up 
the hollow of the armpit, and using the right 
foot to the right shoulder. ( )r, with a pestle. Or, 
with the step of a ladder. Or, by rotation made 
with piece of wood stretched below the arm. 
Treatment: As to attitude, the arm placed by 
the side, the hand and shoulder raised; the 
bandaging and adjustment of the parts while 
in this attitude. If not reduced, the top of the 
shoulder becomes attenuated. 

6. When the acromion is torn away, the ap- 
pearance is the same as in dislocation of the 
shoulder; but there is no impediment, except 
that the bone does not return to its position. The 
figure should be the same as in dislocation, 
both as regards bandaging and suspending the 
limb. The bandaging according to rule. 

y.Whcn partial displacement (sub-luxation?) 
takes place at the elbow, either inside or out- 
side, but the sharp point (olecranon?) remains 
in the cavity of the humerus, make extension in 
a straight line, and push the projecting parts 



Hippocrates 



backward and to the sides. 

8. In complete dislocations to cither side, make 
extension while the arm is in the position it is 
put in to be bandaged for a fracture, for thus 
the rounded part of the elbow will not form an 
obstacle to it. Dislocation most commonly takes 
place inward. The parts are to be adjusted by 
separating the bones as much as possible, so 
that the end of the humerus may not come in 
contact with the olecranon,butitis to be carried 
up and turned round, and not forced in a 
straight line; at the same time the opposite 
sides arc to be pushed together, and the bones 
reduced to their place. In these cases rotation of 
the elbow co-operates; that is to say, turning the 
arm into a state of supination and pronation; so 
much for the reduction. With regard to the at- 
titude in which it is to be put, the hand is to 
be placed somewhat higher than the elbow, and 
the arm by the side; this position suits with it 
when slung from the neck, is easily borne, is 
its natural position, and one adapted for ordi- 
nary purposes, unless callus form improperly: 
the callus soon forms. Treatment: By band- 
ages according to the common rule for articula- 
tions, and the point of the elbow is to be in- 
cluded in the bandage. 

9. The elbow, when luxated, induces the most 
serious consequences, fevers, pain, nausea, vom- 
iting of pure bile; and this especially in disloca- 
tions backward, from pressure on the nerve 
which occasions numbness; next to it is dislo- 
cation forward. The treatment is the same. The 
reduction of dislocation backward is by exten- 
sion and adaptation: the symptom of this va- 
riety, loss of the power of extension; of dislo- 
cation forward, loss of the power of flexion. In 
it a hard ball is to be placed in the bend of the 
elbow, and the fore-arm is to be bent over this 
while sudden extension is made. 

10. Diastasis of the bones may be recognized 
by examining the part where the vein which 
runs along the arm divides. 

1 1. In these cases callus is speedily formed. In 
congenital dislocations, the bones below the seat 
of the injury are shorter than natural; in this 
case, the greatest shortening is in the nearest, 
namely, those of the fore-arm; second, those of 
the hand; third, those of the fingers. The arm 
and shoulders are stronger, owing to the nour- 
ishment which they receive, and the other arm, 
from the additional work it has to perform, is 
still more strong. The wasting of the flesh, 
if the dislocation was outward, is on the in- 
side; or if otherwise, on the side opposite the 
dislocation. 



12. In dislocation at the elbow, whether out- 
ward or inward, extension is to be made with 
the fore-arm at right angles to the arm; the arm 
is to be suspended by a shawl passed through 
the armpit, and a weight is to be attached to the 
extremity of the elbow; or force is to be applied 
with the hands. The articular extremity being 
properly raised, the parts are to be adjusted 
with the palms of the hands, as in dislocations 
of the hands. It is to be bandaged, suspended in 
a sling, and placed, while in this attitude. 

13. Dislocations backward are to be rectified 
with the palms of the hands along with sudden 
extension. These two acts are to be performed 
together, as in other cases of the kind. In dislo- 
cation forward, the arm is to bend around a ball 
of cloth, of proper size, and at the same time 
replaced. 

14. If the displacement be on the other side 
both these operations are to be performed in ef- 
fecting the adjustment of the arm. With regard 
to the treatment, the position and the band- 
aging are the same as in the other cases. For all 
these cases may be reduced by ordinary disten- 
tion. 

15. With regard to the modes of reduction, 
some act upon the principle of carrying the one 
piece of bone over the other, some by extension, 
and some by rotation: these last consist in rapid- 
ly turning the arm to this side and that. 

16. The joint of the hand is dislocated in- 
ward or outward, but most frequently inward. 
The symptoms are easily recognized; if inward, 
the patient cannot at all bend his fingers, but 
if outward, he cannot extend them. Reduction: 
By placing the fingers above a table, exten- 
sion and counter-extension are to be made by 
assistance, while, with the palm of the hand or 
the heel on the projecting bone, one presses for- 
ward, and from behind, upon the other bone, 
and lays some soft substance on it; and, if the 
dislocation be above, the hand is to be turned 
into a state of pronation; or, if backward, into a 
state of supination. The treatment is to be con- 
ducted with bandages. 

17. The whole hand is dislocated either in- 
ward, or outward, but especially inward, or to 
this side or that. Sometimes the epiphysis is dis- 
placed, and sometimes there is displacement 
(diastasis) of the one bone from the other. 
Powerful extension is to be made in this case; 
and the projecting part is to be pressed upon, 
and counter-pressure made on the opposite side: 
both modes being performed at the same time, 
both backward and laterally, either with the 
hands on a table, or with the heel. These ac- 



Instruments of Reduction 



115 



cidents give rise to serious consequences and de- 
formities; but in time the parts get so strong as 
to admit of being used. The treatment consists 
of bandages comprehending the hand and fore- 
arm, and splints are to be applied as far as the 
fingers; when put in splints, they arc to be more 
frequently loosed than in fractures, and more 
copious affusions of water are to be used, 

18. In congenital dislocations the hand be- 
comes shortened, and the atrophy of the flesh is 
generally on the side opposite the dislocation. In 
the adult the bones remain of their proper size. 

19. The symptoms of dislocation of the fin- 
ger are obvious,and need not be described. This 
is the mode of reduction: By stretching in a 
straight line, and making pressure on the pro- 
jecting part, and counter-pressure, at the op- 
posite side, on the other. The proper treatment 
consists in the application of bandages. When 
not reduced, the parts unite by callus outside 
of the joints. In congenital dislocations, and in 
those which occur duringadolescence, the bones 
below the dislocation are shortened, and the 
flesh is wasted principally on the side opposite 
to the dislocation; in the adult the bones remain 
of their proper size. 

20. Dislocation at the hip-joint occurs in four 
modes, inward most frequently, outward next, 
the others of equal frequency. The symptoms: 
The common, a comparison with the sound 
leg. The peculiar symptoms of dislocations in- 
ward; the head of the bone is felt at the perine- 
um; the patient cannot bend his leg as former- 
ly; the limb appears elongated, and to a great 
extent, unless you bring both limbs into the 
middle space between them in making a com- 
parison of them; and the foot and the knee arc 
inclined outward. If the dislocation has taken 
place from birth, or during one's growth, the 
thigh is shortened, the leg less so, and the others 
according to the same rule; the fleshy parts are 
atrophied, especially on the outside. Such per- 
sons are afraid to stand erect, and crawl along 
on the sound limb; or, if compelled, they walk 
with one or two staves, and bear up the affected 
limb; and the smaller the limb so much the 
more easily do they walk. If the accident hap- 
pens to adults the bones remain of their proper 
size, but the flesh is wasted, as formerly de- 
scribed; the patients walk in a wriggling man- 
ner, like oxen; they are bent toward the flank, 
and the buttock on the uninjured side is promi- 
nent; for the uninjured limb must necessarily 
come below that it may support the body, whilst 
the other must be carried out of the way, as it 
cannot support the body, like those who have 



an ulcer in the foot. They poise the body by 
means of a staff on the sound side, and grasp 
the affected limb with the hand above the knee 
so as to carry the body in shifting from one 
place to another. If the parts below the hip- 
joint be used, the bones below are less atro- 
phied, but the flesh more. 

21. The symptoms and attitudes in disloca- 
tion outward are the opposite, and the knee and 
foot incline a little inward. When it is con- 
genital, or occurs during adolescence, the bones 
do not grow properly; according to the same 
rule, the bone of the hip-joint is somewhat high- 
er than natural, and does not grow proportion- 
ally. In those who have frequent dislocations 
outward, without inflammation, the limb is of 
a more humid (flabby? ) temperament than nat- 
ural, like the thumb, for it is the part most fre- 
quently dislocated, owing to its configuration; 
in what persons the dislocation is to a greater 
or less extent; and in what persons it is more 
difficultly or easily produced; in what there is 
reason to hope that it can be speedily reduced, 
and in what not; and the remedy for this; and 
in what cases the dislocation frequently hap- 
pens, and treatment of this. In dislocation out- 
ward from birth, or during adolescence, or from 
disease, (and it happens most frequently from 
disease, in which case there is sometimes ex- 
foliation of the bone, but even where there is 
no exfoliation), the patients experience the same 
symptoms, but to an inferior degree to those in 
dislocations inward, if properly managed so 
that in walking they can put the whole foot to 
the ground and lean to either side. The young- 
er the patient is, the greater care should be be- 
stowed on him; when neglected, the case gets 
worse; when attended to, it improves; and, al- 
though there be atrophy in all parts of the limb, 
it is to a less extent. 

22. When there is a dislocation on both sides, 
the affections of the bones are the same; the 
flesh is well developed, except within, the nates 
protrude, the thighs are arched, unless there be 
sphacelus. If there be curvature of the spine a- 
bove the hip-joint, the patients enjoy good health, 
but the body does not grow, with the exception 
of the head. 

23. The symptoms of dislocation backward 
arc: The parts before more empty, behind they 
protrude, the foot straight, flexion impossible, 
except with pain, extension least of all: in these 
the limb is shortened. They can neither extend 
the limb at the ham, nor at the groin, unless it 
be much raised, nor can they bend it. The up- 
permost joint, in most cases, takes the lead: this 



Hippocrates 



is common in joints, nerves, muscles, intestines, 
uteri, and other parts. There the bone of the hip- 
joint is carried backward to the nates, and on 
that account it is shortened, and because the pa- 
tient cannot extend it. The flesh of the whole 
leg is wasted in all cases, in which most, and to 
what extent, has been already stated. Every part 
of the body which performs its functional work 
is strong, but, if inactive, it gets into a bad con- 
dition, unless its inactivity arise from fatigue, 
fever, or inflammation. And in dislocations out- 
ward, the limb is shortened, because the bone is 
lodged in flesh which yields; but, in disloca- 
tions inward, it is longer, because the bone is 
lodged on a projecting bone. Adults, then, who 
have this dislocation unreduced, are bent at the 
groins in walking, and the other ham is flexed; 
they scarcely reach the ground with the ball of 
the foot; they grasp the limb with the hand, 
and walk without a staff if they choose; if the 
stafl be too long, their foot cannot reach the 
ground, if they wish to reach the ground, they 
must use a short staff. There is wasting of the 
flesh in cases attended with pain; and the in- 
clination of the leg is forward, and the sound 
leg in proportion. In congenital cases, or when 
in adolescence, or from disease, the bone is dis- 
located (under what circumstances will be ex- 
plained afterward), the limb is particularly im- 
paired, owing to the nerves and joints not being 
exercised, and the knee is impaired for the rea- 
sons stated. These persons, keeping the limb 
bent, walk with one staff or two. But the sound 
limb is in good flesh from usage. 

24. In dislocations forward the symptoms are 
the opposite: a vacuity behind, a protuberance 
before; of all motions they can least perform 
flexion, and extension best; the foot is straight, 
the limb is of the proper length at the heel; at 
its extremity the foot a little turned up; they are 
especially pained at first: of all these disloca- 
tions retention of urine occurs most frequently 
in this variety, because the bone is lodged a- 
mong important nerves. The fore parts are 
stretched, do not grow, are diseased, and are 
obnoxious to premature decay; the back parts 
are wrinkled. In the case of adults, they walk 
erect, resting merely on the heel, and this they 
do decidedly if they can take great steps; but 
they drag it along; the wasting is least of all in 
this variety of dislocation, owing to their being 
able to use the limb, but the wasting is most 
behind. The whole limb being straighter than 
natural they stand in need of a staff on the af- 
fected side. When the dislocation is congenital, 
or has occurred during adolescence, if properly 



managed, the patient has the use of the limb 
as well as adults (otherwise?) have of it. But, 
if neglected, it is shortened and extended, for 
in such cases the joint is generally ankylosed 
in a straight position. The diminution of the 
bones, and wasting of the fleshy parts, are anal- 
ogous. 

25. In reduction the extension of the thigh 
is to be powerful, and the adjustment what is 
common in all such cases, with the hands, or a 
board, or a lever, which, in dislocations inward, 
should be round, and in dislocations outward, 
flat; but it is mostly applicable in dislocations 
outward. Dislocations inward are to be rem- 
edied by means of bladders, extending to the 
bare part of the thigh, along with extension 
and binding together of the limbs. The patient 
may be suspended, with his feet a little sepa- 
rated from one another, and then a person in- 
serting his arm within the affected limb, is to 
suspend himself from it, and perform extension 
and readjustment at the same time; and this 
method is sufficient in dislocations forward and 
the others, but least of all in dislocations back- 
ward. A board fastened under the limb, like the 
board fastened below the arm in dislocations at 
the shoulder, answers in dislocations inward, 
but less so in the other varieties. Along with ex- 
tension you will use pressure either with the 
foot, the hand, or a board, especially in disloca- 
tions forward and backward. 

26. Dislocations at the knee are of a milder 
character than those of the elbow, owing to the 
compactness and regularity of the joint; and 
hence it is more readily dislocated and reduced. 
Dislocation generally takes place inward, but 
also outward and backward. The methods of 
reduction are by circumflexion, or by rapid 
excalcitration, or by rolling a fillet into a ball, 
placing it in the ham, and then letting the pa- 
tient's body suddenly drop down on his knees: 
this mode applies best in dislocations backward. 
Dislocations back ward, like those of the elbows, 
may also be reduced by moderate extension. 
Lateral dislocations may be reduced by circum- 
flexion or excalcitration, or by extension (but 
this is most applicable in dislocation backward), 
but also by moderate extension. The adjustment 
is what is common in all. If not reduced, in dis- 
locations backward, they cannot bend the leg 
and thigh upon one another, but neither can 
they do this in the others except to a small ex- 
tent; and the fore parts of the thigh and leg are 
wasted. In dislocations inward they are bandy- 
legged, and the external parts are atrophied. 
But, in dislocations outward, they incline more 



Instruments of Reduction 



12-7 



outward, but arc less lame, for the body is sup- 
ported on the thicker bone, and the inner parts 
are wasted. The consequences of a congenital 
dislocation, or one occurring during adoles- 
cence, are analogous to the rule formerly laid 
down. 

27. Dislocations at the ankle-joint require 
strong extension, either with the hands or some 
such means, and adjustment, which at the same 
time effects both acts; this is common in all 
cases. 

28. Dislocations of the bones of the foot are 
to be treated like those of the hand. 

29. Dislocations of the bones connected with 
the leg, if not reduced, whether occurring at 
birth or during adolescence, are of the same 
character as those in the hand. 

30. Persons who, in jumping from a height, 
have pitched on the heel, so as to occasion dias- 
tasis (separation) of the bones, ecchymosis of 
the veins, and contusion of the nerves, when 
these symptoms are very violent, there is dan- 
ger that the parts may sphacelate, and give trou- 
ble to the patient during the remainder of his 
life; for these bones are so constructed as to slip 
past one another, and the nerves communicate 
together. And, likewise in cases of fracture, 
either from an injury in the leg or thigh, or in 
paralysis of the nerves connected with these 
parts, or, when in any other case of confinement 
to bed the heel, from neglect, becomes blacken- 
ed, in all these cases serious effects result there- 
from. Sometimes, in addition to the sphacelus, 
very acute fevers supervene, attended with hic- 
cup, tumors, aberration of intellect, and speedy 
death, along with lividity of the large blood- 
vessels, and gangrene. The symptoms of the 
exacerbations are these: if the ecchymosis, the 
blackened parts, and those around them, be 
somewhat hard and red, and if lividity be com- 
bined with the hardness, there is danger of mor- 
tification; but, if the parts are sublivid, or even 
very livid and diffused, or greenish and soft, 
these symptoms, in all such cases, are favorable. 
The treatment consists in the administration of 
hellebore, if they be free from fever, but other- 
wise, they are to have oxyglyty for drink, if re- 
quired. Bandaging, agreeably to the rule in 
other joints; but this is to be attended to also, 
the bandages should be numerous, and softer 
than usual; compression less; more water than 
usual to be used in the affusions; to be applied 
especially to the heel. The same object should 
be sought after in the position as in the band- 
aging, namely, that the humors may not be de- 
termined to the heel; the limb to be well laid 



should have the heel higher than the knee. 
Splints not to be used. 

31. When the foot is dislocated, either alone, 
or with the epiphysis, the displacement is more 
apt to be inward. If not reduced, in the course 
of time the parts of the hips, thigh, and leg, 
opposite the dislocation, become attenuated. Re- 
duction: As in dislocation at the wrist; but the 
extension requires to be very powerful. Treat- 
ment: Agreeably to the rule laid down for the 
other joints. Less apt to be followed by serious 
consequences than the wrist, if kept quiet. Diet 
restricted, as being in an inactive state. Those 
occurring at birth, or during adolescence, ob- 
serve the rule formerly stated. 

32. With regard to slight congenital disloca- 
tions, some of them can be rectified, especially 
club-foot. There is more than one variety of 
club-foot. The treatment consists in modeling 
the foot like a piece of wax; applying resinous 
cerate, and numerous bandages; or a sole, or a 
piece of lead is to be bound on, but not upon the 
bare skin; the adjustment and attitudes to corre- 
spond. 

33. If the dislocated bones cause a wound in 
the skin, and protrude, it is better to let them 
alone, provided only they are not allowed to 
hang, nor are compressed. The treatment con- 
sists in applying pitched cerate, or compresses 
dipped in hot wine (for cold is bad in all such 
cases), and certain leaves; but in winterunwash- 
ed wool may be applied as a cover to the part; 
neither cataplasms nor bandaging; restricted 
diet. Cold, great weight, compression, violence, 
restricted position, all such are to be accounted 
as fatal measures. When treated moderately 
(they escape), maimed and deformed; for, if the 
dislocation be at the ankle, the foot is drawn up- 
ward, and, if elsewhere, according to the same 
rule. The bones do not readily exfoliate; for 
only small portions of them are denuded, and 
they heal by narrow cicatrices. The danger is 
greatest in the greatest joints, and those highest 
up. The only chance of recovery is, if they arc 
not reduced, except at the fingers and hand, 
and in these cases the danger should be an- 
nounced beforehand. Attempts at reduction to 
be made on the first or second day; or, if not 
accomplished then, on the tenth, by no means 
on the fourth. Reduction by levers. Treatment: 
As in injuries of the bones of the head, and 
the part is to be kept hot; and it is better to give 
hellebore immediately after the parts have been 
reduced. With regard to the other bones, it 
should be well known, that, if replaced, death 
will be the consequence; the more surely and 



12.8 



Hippocrates 



cxpcditiously, the greater the articulation, and 
the more high its situation. Dislocation of the 
foot is attended with spasm (tetanus) and gan- 
grene; and if, upon its being replaced, any of 
these symptoms come on, the chance of recov- 
ery, if there be any chance, is in displacing it 
anew; for spasms do not arise from relaxation, 
but from tension of the parts. 

34. Excision, either of articular bones or of 
pieces of bones, when not high up in the body, 
but about the foot or the hand, is generally fol- 
lowed by recovery, unlessthe patient die at once 
from deliquium animi. Treatment: As in in- 
juries of the head; warmth. 

35. Sphacclus of the fleshy parts is produced 
by the tight compression of bleeding wounds, 
and by pressure in the fractures of bones, and 
by blackening, arising from bandages. And in 
those cases in which a portion of the thigh orarm, 
both the bones and the flesh drop off, many re- 
cover, the case being less dangerous than many 
others. In cases, then, connected with fracture 
of the bones, the separation of the flesh quickly 
takes place, but the separation of the bone, at 
the boundary of its denuded part, is slower in 
taking place. But the parts below the seat of the 
injury, and the sound portion of the body, are 
to be previously taken away (for they die pre- 
viously), taking care to avoid producing pain, 
for deliquium animi may occasion death. The 
bone of the thigh in such a case came away on 
the eightieth day, but the leg was removed on 
the twentieth day. The bones of the leg, in a 
certain case, came away at the middle of the 
sixtieth day. In these cases the separation is 
quick or slow, according to the compression ap- 
plied by the physician. When the compression 
is gently applied the bones do not drop off at 
all, neither are they denuded of flesh, but the 
gangrene is confined in the more superficial 
parts. The treatment of such cases must be un- 
dertaken; for most of them are more formidable 
in appearance than in reality. The treatment 
should be mild, but, with a restricted diet; hem- 
orrhages and cold are to be dreaded; the posi- 
tion, so as that the limb may be inclined up- 
ward, and afterward, on account of the puru- 
lent abscess, horizontally, or such as may suit 
with it. In such cases, and in mortifications, 
there are, usually, about the crisis, hemorrhages 
and violent diarrhoeas, which, however, only last 
for a few days; the patients do not lose their ap- 
petite, neither are they feverish, nor should they 
be put upon a reduced diet. 

36. Displacement of the spine, if inward, 
threatens immediate death, attended with re- 



tention of urine and loss of sensibility. Out- 
ward, the accident is free from most of these bad 
effects, much more so than where there is mere- 
ly concussion without displacement; the effects 
in the former case being confined to the spot 
affected, whereas in the latter they are further 
communicated to the whole body, and are of a 
mortal character. In like manner, when the ribs 
are fractured, whether one or more, provided 
there be no splinters, there is rarely fever, spit- 
ting of blood, and sphacelus, and ordinary treat- 
ment without evacuation will suffice, provided 
there be no fever; bandaging, according to 
rule; and the callus forms in twenty days, the 
bone being of a porous nature. But in cases of 
contusion, tubercles form, along with cough, 
suppurating sores, and sphacelus of the ribs, for 
nerves from all the parts run along each rib. In 
many of these cases haemoptysis and empyema 
also take place. The management of this case 
consists in careful treatment, bandaging accord- 
ing to rule, diet at first restricted, but afterward 
more liberal, quiet, silence, position, bowels, and 
venereal matters regulated. Even when there is 
no spitting of blood, these contusions are more 
painful than fractures, and are more subject 
in time to relapses; and when any mucous col- 
lection is left in the part, it makes itself be felt 
in disorders of the body. Treatment: burning, 
when the bone is affected, down to the bone, 
but not touching the bone itself; if in the in- 
tercostal space, the burning must not extend 
through it, nor be too superficial. In sphacelus 
of the ribs, tents are to be tried, all other particu- 
lars will be stated afterward : but they should be 
learned by sight rather than by words, namely, 
food, drink, heat, cold, attitude; medicines, dry, 
liquid, red, dark, white, sour, for the ulcers, and 
so with regard to the diet. 

37. Displacements (of the vertebrce) from a 
fall rarely admit of being rectified, and those 
above the diaphragm are most difficult to rectify. 
When the accident happens to children, the 
body does not grow, with the exception of the 
legs, the arms, and head. Excurvation, in adults, 
speedily relieves the individual from the dis- 
ease he is laboring under, but in time it renews 
its attack, with the same symptoms as in chil- 
dren, but of a less serious nature. Some individ- 
uals have borne this affection well, and have 
turned out to be brawny and fat. But few of 
them have lived to the age of sixty. Lateral 
curvatures also occur, the proximate cause of 
which is the attitudes in which these persons 
lie. These cases have their prognostics accord- 
ingly. 



Instruments of Reduction 



38. The rule for the reduction and adjust- 
ment: The axle, the lever, the wedge, pressure 
above; the axle to separate, the lever to push 
aside. Reduction and adjustment are to be ac- 
complished by forcible extension, the parts be- 
ing placed in such a position as will facilitate 
the conveying of the displaced bone over the 
extremity of the bone from which it was dis- 
placed: this is to be accomplished either with 
the hands, or by suspension, or axles, or turned 
round something. With the hands this is to be 
effected properly, according to the structure 
of the parts. In the case of the wrist and elbow, 
the parts are to be forced asunder, at the wrist 
in the line of the elbow, and the elbow with the 
fore-arm at a right angle with the arm, as when 
it is suspended in a sling. When we want to 
separate the protruding bones, and force them 
into place, in the case of the fingers, the toes, or 
the wrist, the proper separation may be made by 
hands, while the projecting part is forced into its 
place by pressing down with the heel or the palm 
of the hand upon some resisting object, while 
something moderately soft is laid under the pro- 
jecting part, but nothing such under the other, 
and then pressure is to be made backward and 
downward, whether the dislocation be inward or 
outward. In lateral displacement, pressure and 
counter-pressure must be made on the opposite 
sides. Displacements forward can be reduced 
neither by sneezing, nor coughing, nor by the 
injection of air, nor by the cupping-instrument; 
and if anything can do good in such a case, it 
is extension. People are deceived in fractures of 
the spinal processes, the pain of which causing 
the patient to stoop forward, the case is taken 
for dislocation inward; these fractures heal 
speedily and easily. Dislocation outward is to be 
remedied by succussion, when high up, toward 
the feet; and when situated low down, in the 
contrary direction; the part isto be pressed back 
into its place, either with the foot or a board. 
Dislocations to either side, if they admit of any 
remedy, are to be treated by extension, and suit- 
able attitudes, with regimen. The whole appa- 
ratus should be broad, soft, and strong; or other- 
wise, they should be wrapped in rags; before 
being used, they should all be prepared pro- 
portionately to the length, height, and breadth. 
In applying extension to the thigh, for example, 
the bands should be fastened at the ankle and 
above the knee, these stretching in the same di- 
rection, another band to be passed by the loins, 
and around the armpits, and by the perineum 
and thigh, one end passing up the breast and 
the other along the back, these all stretching in 



the same direction and being fastened either to 
a piece of wood resembling a pestle or to an 
axle. When this is done on a couch, either of its 
feet is to be fastened to the threshold, and a 
strong block of wood is to be laid across the 
other, and the pieces of wood resembling a pestle 
are to be raised on these, to make extension and 
counter-extension; the naves of a wheel are to 
be fastened in the floor, or a ladder is to be ad- 
justed, so that extension may be made in both 
directions. The thing commonly used is a bench 
six cubits long, two cubits broad, one fathom 
in thickness, having two low axles at this end 
and that, and having at its middle two moderate- 
sized pillars, to which is to be adjusted a trans- 
verse piece of wood like the step of a ladder, 
which is to receive the piece of wood tied below 
the limb, as is done in dislocation at the shoulder; 
and the bench is to have excavations like trays, 
smooth, four inches in breadth and depth, and 
at such an interval as to leave room for the lever 
used to reduce the limb. In the middle of the 
bench a square hole is to be scooped out to re- 
ceive a small pillar, which, being adjusted to 
the perineum, will obviate the tendency of the 
body to slip downward, and being rather loose 
may act somewhat as a lever. In certain occa- 
sions a piece of wood is required, which is in- 
serted into a hole scooped out of the wall; the 
other end of it is then to be pressed down, some- 
thing moderately soft being placed under it. 

39. In those cases where the bone of the palate 
has exfoliated, the nose sinks in its middle. In 
contusions of the head without a wound, either 
from a fall, a fracture, or pressure, in certain of 
these cases acrid humors descend from the head 
to the throat, and from the wound in the head 
to the liver and thigh. 

40. The symptoms of subluxations and luxa- 
tions, and where, and how, and how much these 
differ from one another. And the cases in which 
the articular cavity has been broke off, and in 
which the ligament has been torn, and in which 
the epiphysishas been broken off; and in which, 
and how, when the limb consists of two bones, 
one or both are broken: in consequence of these 
the dangers, chances in which bad, and when 
the injuries will result in death, and when in 
recovery. What cases are to be reduced or at- 
tempted, and when, and which, and when not; 
the hopes and dangers in these cases. Which and 
when congenital dislocations are to be undertak- 
en: the parts in a state of growth, the parts fully 
grown, and why sooner, or slower: and why a 
part becomes maimed, and how, and how not: 
and why a certain part is atrophied, and where, 



130 Hippocrates 

and how, and in what cases to a less extent. And 
why fractured parts unite sooner or slower, how 
distortions and callosities form, and the reme- 
dy for them. In what cases there are external 
wounds, either at first or afterwards: in what 
fractures the bones arc shortened, and in what 
not: in what cases the fractured bones protrude, 
and when they protrude most: in what cases 
dislocated bones protrude. That physicians are 
deceived, and by what means, in what they see, 
and in what they devise, regarding affections, 
and regarding cures. Established rules with re- 
gard to bandaging preparation, presentation of 
the part, extension, adjustment, friction, band- 
aging, suspension and placing of the limb, at- 
titude, seasons, diet. The most porous parts heal 
fastest, and vice versa. Distortions, where the 
bones arccrooked. Flesh and tendons wasted on 
the side of the dislocation. The force used in re- 
duction to be applied at as great a distance as 
possible from the scat of the displacement. Of 
nerves (ligaments?), those which are in mo- 
tion and in humidity (flabby?) are of a yield- 
ing nature; those that are not, less so. In every 
dislocation the most speedy reduction is best. 
Reduction not to be made while the patient is in 
a febrile state, nor on the fourth or fifth day; and 
least of all, in those of the elbow, and all cases 
which induce torpor; the soonest the best, pro- 
vided the inflammatory stage be avoided. Parts 
torn asunder, whether nerves, or cartilages, or 
cpiphyses, or parts separated at symphyses, can- 
not possibly be restored to their former state; 
but callus is quickly formed in most cases, yet 
the use of the limb is preserved. Of luxations, 
those nearest the extremities are least danger- 
ous. Those joints which are most easily dislo- 
cated are the least subject to inflammation. 
Those which have been least inflamed, and have 
not been subjected to after-treatment, are most 
liable to be dislocated anew. Extension should 
be made in the position most calculated to en- 
able the one bone to clear the extremity of the 
other, attention being paid to configuration and 
place. Adjustment to be made in the direction 
of the displacement; to push the displaced limb 
straight backward and sideways. Parts sudden- 
ly drawn aside are to be suddenly drawn back 
by a rotatory motion. Articulations which have 
been oftcncst dislocated are the most easily re- 
duced; the cause is the conformation of the 
nerves (ligaments?) or of the bones; of theliga- 
mcnts that they are long and yielding; and of 
the bones, the shallowness of the articular cavi- 
ty, and roundness of the head [of the bone that 



enters it]. Usage, by its friction, forms a new 
socket. The cause the disposition, and habit, 
and age. A part somewhat mucous is not sub- 
ject to inflammation. 

41. In those cases where there are wounds, 
cither at first, or from protrusion of the bones; or 
afterward, from pruritus, or irritation; in the lat- 
ter case you are immediately to unloose the band- 
ages, and having applied pitched cerate to the 
wound, bandage the limb, placing the head of the 
roller upon the wound, and proceeding other- 
wise as if there were no wound in the case; for 
thus will the swelling be reduced as much as 
possible, and the wound will suppurate most 
quickly, and the diseased parts will separate, 
and when it becomes clean the wound will most 
quickly heal. Splints are not to be applied to 
the place, nor is it to be bound tight. Proceed 
thus when no large bones exfoliate, but not in 
the latter case, for then there is great suppura- 
tion, and the same treatment is not applicable, 
but the parts require to be exposed to the air 
on account of the abscesses. In such cases where 
the bones protrude, and whether reduced or not, 
bandaging is not befitting, but distention is to 
be practiced by means of rolls of cloth, made 
like those used upon shackles; one of these is to 
be placed at the ankle, and the other at the knee; 
they are to be flattened toward the leg, soft, 
strong, and having rings; and rods made of 
cornel, and of a proper length and thickness 
are to be adjusted to them, so as to keep the 
parts distended; and straps, attached to both ex- 
tremities, are to be inserted into the rings, so 
that the extremities being fixed into the rolls, 
may effect distention. Treatment: Pitched ce- 
rate, in a hot state; the attitudes, position of the 
foot and hip; regulated diet. The bones which 
have protruded through the skin are to be re- 
placed the same day, or next; not on the fourth 
or fifth, but when the swelling has subsided. 
Reduction is to be performed with levers; when 
the bone does not present any place upon which 
the lever can rest, a portion of the part which 
prevents this is to be sawed off. But the de- 
nuded parts will drop off, and the limb become 
shortened. 

42. Dislocations at the joints arc to a greater 
and less extent. Those that are to a less extent 
are the most easily reduced; those that arc to 
a greater extent occasion lesions of the bones, 
of the ligaments, of the joints, of the fleshy 
parts, and of the attitudes. The thigh and arm 
resemble one another very much in their dis- 
locations. 



Aphorisms 



SECTION I 

LIFE is short, and Art long; the crisis fleet- 
ing; experience perilous, and decision diffi- 
cult. The physician must not only be prepared 
to do what is right himself, but also to make 
the patient, the attendants, and externals co- 
operate. 

2. In disorders of the bowels and vomitings, 
occurring spontaneously, if the matters purged 
be such as ought to be purged, they do good, 
and are well borne; but if not, the contrary. And 
so artificial evacuations, if they consist of such 
matters as should be evacuated, do good, and 
are well borne; but if not, the contrary. One, 
then, ought to look to the country, the season, 
the age, and the diseases in which they are prop- 
er or not. 

3. In the athletae, embonpoint, if carried to its 
utmost limit, is dangerous, for they cannot re- 
main in the same state nor be stationary; and 
since, then, they can neither remain stationary 
nor improve, it only remains for them to get 
worse; for these reasons the embonpoint should 
be reduced without delay, that the body may 
again have a commencement of reparation. 
Neither should the evacuations, in their case, be 
carried to an extreme, for this also is dangerous, 
but only to such a point as the person's consti- 
tution can endure. In like manner, medicinal 
evacuations, if carried to an extreme, are dan- 
gerous; and again, a restorative course, if in the 
extreme, is dangerous. 

4. A slender and restricted diet is always dan- 
gerous in chronic diseases, and also in acute dis- 
eases, where it is not requisite. And again, a 
diet brought to the extreme point of attenuation 
is dangerous; and repletion, when in the ex- 
treme, is also dangerous. 

5. In a restricted diet, patients who transgress 
are thereby more hurt (than in any other?); for 
every such transgression, whatever it may be, 
is followed by greater consequences than in a 
diet somewhat more generous. On this account, 
a very slender, regulated, and restricted diet is 
dangerous to persons in health, because they 
bear transgressions of it more difficultly. For this 
reason, a slender and restricted diet is generally 
more dangerous than one a little more liberal. 

6. For extreme diseases, extreme methods of 
cure, as to restriction, are most suitable. 

7. When the disease is very acute, it is attend- 
ed with extremely severe symptoms in its first 



stage; and therefore an extremely attenuating 
diet must be used. When this is not the case, but 
it is allowable to give a more generous diet, we 
may depart as far from the severity of regimen 
as the disease, by its mildness, is removed from 
the extreme. 

8. When the disease is at its height, it will 
then be necessary to use the most slender diet. 

9. We must form a particular judgment of 
the patient, whether he will support the diet 
until the acme of the disease, and whether he 
will sink previously and not support the diet, or 
the disease will give way previously, and be- 
come less acute. 

10. In those cases, then, which attain their ac- 
me speedily, a restricted diet should bcenjoincd 
at first; but in those cases which reach their ac- 
me later, we must retrench at that period or a 
little before it; but previously we must allow a 
more generous diet to support the patient. 

11. We must retrench during paroxysms, for 
to exhibit food would be injurious. And in all 
diseases having periodical paroxysms, we must 
restrict during the paroxysms. 

12. The exacerbations and remissions will be 
indicated by the diseases, the seasons of the year, 
the reciprocation of the periods, whether they 
occur every day, every alternate day, or after a 
longer period, and by the supervening symp- 
toms; as, for example, in pleuritic cases, expec- 
toration, if it occur at the commencement, short- 
ens the attack, but if it appear later, it prolongs 
the same; and in the same manner the urine, 
and alvine discharges, and sweats, according as 
they appear along with favorable or unfavor- 
able symptoms, indicate diseases of a short or 
long duration. 

13. Old persons endure fasting most easily; 
next, adults; young persons not nearly so well; 
and most especially infants, and of them such 
as are of a particularly lively spirit. 

1 4. Growing bodies have the most innate heat; 
they therefore require the most food, for other- 
wise their bodies are wasted. In old persons the 
heat is feeble, and therefore they require little 
fuel, as it were, to the flame, for it would be ex- 
tinguished by much. On this account, also, fe- 
vers in old persons arc not equally acute, be- 
cause their bodies are cold. 

15. In winter and spring the bowels are natu- 
rally the hottest, and the sleep most prolonged; 
at these seasons, then, the most sustenance is to 
be administered; for as the belly has then most 



Hippocrates 



innate heat, it stands in need of most food. The 
well-known facts with regard to young persons 
and the athlctae prove this. 

16. A humid regimen is befitting in all febrile 
diseases, and particularly in children, and oth- 
ers accustomed to live on such a diet. 

17. We must consider, also, in which cases 
food is to be given once or twice a day, and in 
greater or smaller quantities, and at intervals. 
Something must be conceded to habit, to sea- 
son, to country, and to age. 

1 8. Invalids bear food worst during summer 
and autumn, most easily in winter, and next in 
spring. 

19. Neither give nor enjoin anything to per- 
sons during periodical paroxysms, but abstract 
from the accustomed allowance before the cri- 
sis. 

20. When things are at the crisis, or when 
they have just passed it, neither move the bow- 
els, nor make any innovation in the treatment, 
cither as regards purgatives or any other such 
stimulants, but let things alone. 

21. Those things which require to be evacu- 
ated should be evacuated, wherever they most 
tend, by the proper outlets. 

22. We must purge and move such humors 
as arc concocted, not such as arc unconcoctcd, 
unless they are struggling to get out, which is 
mostly not the case. 

23. The evacuations arc to be judged of not 
by their quantity, but whether they be such as 
they should be, and how they are borne. And 
when proper to carry the evacuation to dc- 
liquium animi, this also should be done, pro- 
vided the patient can support it. 

24. Use purgative medicines sparingly in 
acute diseases, and at the commencement, and 
not without proper circumspection. 

25. If the matters which arc purged be such 
as should be purged, the evacuation is beneficial, 
and easily borne; but, if otherwise, with diffi- 
culty. 

SECTION II 

1. In whatever disease sleep is laborious, it is 
a deadly symptom; but if sleep does good, it is 
not deadly. 

2. When sleep puts an end to delirium, it is 
a good symptom. 

3. Both sleep and insomnolency, when im- 
moderate, arc bad. 

4. Neither repletion, nor fasting, nor any- 
thing else, is good when more than natural. 

5. Spontaneous lassitude indicates disease. 

6. Per sons who have a painful affection in any 



part of the body, and are in a great measure in- 
sensible of the pain, are disordered in intellect. 

7. Those bodies which have been slowly ema- 
ciated should be slowly recruited; and those 
which have been quickly emaciated should be 
quickly recruited. 

8. When a person after a disease takes food, 
but docs not improve in strength, it indicates 
that the body uses more food than is proper; 
but if this happen when he does not take food, 
it is to be understood that evacuation is required. 

9. When one wishes to purge, he should put 
the body into a fluent state. 

10. Bodies not properly cleansed, the more 
you nourish the more you injure. 

1 1. It is easier to fill up with drink than with 
food. 

12. What remains in diseases after the crisis 
is apt to produce relapses. 

13. Persons in whom a crisis takes place pass 
the night preceding the paroxysm uncomfort- 
ably, but the succeeding night generally more 
comfortably. 

14. In fluxes of the bowels, a change of the de- 
jections docs good, unless the change be of a 
bad character. 

15. When the throat is diseased, or tubercles 
(phymatd) form on the body, attention must be 
paid to the secretions; for if they be bilious, the 
disease affects the general system; but if they re- 
semble those of a healthy person, it is safe to 
give nourishing food. 

1 6. When in a state of hunger, one ought not 
to undertake labor. 

17. When more food than is proper has been 
taken, it occasions disease; this is shown by the 
treatment. 

1 8. From food which proves nourishing to 
the body either immediately or shortly, the de- 
jections also are immediate. 

19. In acute diseases it is not quite safe to 
prognosticate either death or recovery. 

20. Those who have watery discharges from 
their bowels when young have dry when they 
are old ; and those who have dry discharges when 
they are young will have watery when they arc 
old. 

21. Drinking strong wine cures hunger. 

22. Diseases which arise from repletion are 
cured by depletion; and those that arise from 
depletion are cured by repletion; and in gener- 
al, diseases arc cured by their contraries. 

23. Acute disease come to a crisis in fourteen 
days. 

24. The fourth day is indicative of the sev- 
enth; the eighth is the commencement of the 



second week; and hence, the eleventh being the 
fourth of the second week, is also indicative; 
and again, the seventeenth is indicative, as be- 
ing the fourth from the fourteenth, and the sev- 
enth from the eleventh. 

25. The summer quartans are, for the most 
part, of short duration; but the autumnal are 
protracted, especially those occurring near the 
approach of winter. 

26. It is better that a fever succeed to a con- 
vulsion, than a convulsion to a fever. 

27. We should not trust ameliorations in dis- 
eases when they are not regular, nor be much 
afraid of bad symptoms which occur in an ir- 
regular form; for such are commonly incon- 
stant, and do not usually continue, nor have any 
duration. 

28. In fevers which are not altogether slight, 
it is a bad symptom for the body to remain 
without any diminution of bulk, or to be wasted 
beyond measure; for the one state indicates a 
protracted disease, and the other weakness of 
body. 

29. If it appear that evacuations are required, 
they should be made at the commencement of 
diseases; at the acme it is better to be quiet. 

30. Toward the commencement and end of 
diseases all the symptoms are weaker, and to- 
ward the acme they are stronger. 

31. When a person who is recovering from a 
disease has a good appetite, but his body does 
not improve in condition, it is a bad symptom. 

32. For the most part, all persons in ill health, 
who have a good appetite at the commence- 
ment, but do not improve, have a bad appetite 
again toward the end; whereas, those who have 
a very bad appetite at the commencement, and 
afterward acquire a good appetite, get better off. 

33. In every disease it is a good sign when the 
patient's intellect is sound, and he is disposed to 
take whatever food is offered to him; but the 
contrary is bad. 

34. In diseases, there is less danger when the 
disease is one to which the patient's constitu- 
tion, habit, age, and the season are allied, than 
when it is one to which they are not allied. 

35. In all diseases it is better that the umbili- 
cal and hypogastric regions preserve their full- 
ness; and it is a bad sign when they arc very 
slender and emaciated; in the latter case it is 
dangerous to administer purgatives. 

36. Persons in good health quickly lose their 
strength by taking purgative medicines, or us- 
ing bad food. 

37. Purgative medicines agree ill with per- 
sons in good health. 



Aphorisms 133 

38. An article of food or drink which is slight- 
ly worse, but more palatable, is to be preferred 
to such as are better but less palatable. 

39. Old people, on the whole, have fewer com- 
plaints than young; but those chronic diseases 
which do befall them generally never leave them. 

40. Catarrhs and coryza in very old people 
are not concocted. 

41. Persons who have had frequent and se- 
vere attacks of swooning, without any manifest 
cause, die suddenly. 

42. It is impossible to remove a strong attack 
of apoplexy, and not easy to remove a weak at- 
tack. 

43. Of persons who have been suspended by 
the neck, and are in a state of insensibility, but 
not quite dead, those do not recover who have 
foam at the mouth. 

44. Persons who are naturally very fat are apt 
to die earlier than those who are slender. 

45. Epilepsy in young persons is most fre- 
quently removed by changes of air, of country, 
and of modes of life. 

46. Of two pains occurring together, not in 
the same part of the body, the stronger weak- 
ens the other. 

47. Pains and fevers occur rather at the for- 
mation of pus than when it is already formed. 

48. In every movement of the body, when- 
ever one begins to endure pain, it will be re- 
lieved by rest. 

49. Those who are accustomed to endure ha- 
bitual labors,although they be weak or old, bear 
them better than strong and young persons who 
have not been so accustomed. 

50. Those things which one has been accus- 
tomed to for a long time, although worse than 
things which one is not accustomed to, usually 
give less disturbance; but a change must some- 
times be made to things one is not accustomed 
to. 

51. To evacuate, fill up, heat, cool, or other- 
wise, move the body in any way much and sud- 
denly, is dangerous; and whatever is excessive 
is inimical to nature; but whatever is done by 
little and little is safe, more especially when a 
transition is made from one thing to another. 

52. When doing everything according to in- 
dications, although things may not turn out a- 
greeably to indication, we should not change to 
another while the original appearances remain. 

53. Those persons who have watery discharges 
from the bowels when they are young, come off 
better than those who have dry; but in old age 
they come off worse, for the bowels in aged per- 
sons are usually dried up. 



134 

54- Largeness of person in youth is noble and 
not unbecoming; but in old age it is inconven- 
ient, and worse than a smaller structure. 



SECTION III 

1. The changes of the season mostly engen- 
der diseases, and in the seasons great changes 
either of heat or of cold, and the rest agreeably 
to the same rule. 

2. Of natures (temperaments?), some are 
well- or ill-adapted for summer, and some for 
winter. 

3. Of diseases and ages, certain of them are 
well- or ill-adapted to different seasons, places, 
and kinds of diet. 

4. In the seasons, when during the same day 
there is at one time heat and at another time 
cold, the diseases of autumn may be expected. 

5. South winds induce dullness of hearing, 
dimness of visions, heaviness of the head, tor- 
por, and languor; when these prevail, such symp- 
toms occur in diseases. But if the north wind 
prevail, coughs, affections of the throat, hard- 
ness of the bowels, dysuria attended with rig- 
ors, and pains of the sides and breast occur. 
When this wind prevails, all such symptoms 
may be expected in diseases. 

6. When summer is like spring, much sweat- 
ing may be expected in fevers. 

7. Acute diseases occur in droughts; and if 
the summer be particularly such, according to 
the constitution which it has given to the year, 
for the most part such diseases maybe expected. 

8. In seasons which arc regular, and furnish 
the productions of the season at the seasonable 
time, the diseases are regular, and come readily 
to a crisis; but in inconstant seasons, the dis- 
eases are irregular, and come to a crisis with 
difficulty. 

9. In autumn, diseases are most acute, and 
most mortal, on the whole. The spring is most 
healthy, and least mortal. 

10. Autumn is a bad season for persons in 
consumption. 

1 1 . With regard to the seasons, if the winter 
be of a dry and northerly character, and the 
spring rainy and southerly, in summer there 
will necessarily be acute fevers, ophthalmies, and 
dysenteries, especially in women, and in men of 
a humid temperament. 

12. If the winter be southerly, rainy, and calm, 
but the spring dry and northerly, women whose 
term of delivery should be in spring, have a- 
bortions from any slight cause; and those who 
reach their full time, bring forth children who 
are feeble, and diseased, so that they either die 



Hippocrates 

presently, or, if they live, are puny and un- 
healthy. Other people are subject to dysenteries 
and ophthalmies, and old men to catarrhs, which 
quickly cut them off. 

13. If the summer be dry and northerly and 
the autumn rainy and southerly, headaches oc- 
cur in winter, with coughs, hoarsenesses, cory- 
zae, and in some cases consumptions. 

14. But if the autumn be northerly and dry, 
it agrees well with persons of a humid temper- 
ament, and with women; but others will be sub- 
ject to dry ophthalmies, acute fevers, coryzae, 
and in some cases melancholy. 

15. Of the constitutions of the year, the dry, 
upon the whole, are more healthy than the rainy, 
and attended with less mortality. 

16. The diseases which occur most frequent- 
ly in rainy seasons are, protracted fevers, fluxes 
of the bowels, mortifications, epilepsies, apo- 
plexies, and quinsies; and in dry, consumptive 
diseases, ophthalmies, arthritic diseases, stran- 
guries, and dysenteries. 

17. With regard to the states of the weather 
which continue but for a clay, that which is 
northerly, braces the body, giving it tone, agili- 
ty, and color, improves the sense of hearing, dries 
up the bowels, pinches the eyes, and aggravates 
any previous pain which may have been seated 
in the chest. But the southerly relaxes the body, 
and renders it humid, brings on dullness of 
hearing, heaviness of the head, and vertigo, im- 
pairs the movements of the eyes and the whole 
body, and renders the alvine discharges watery. 

1 8. With regard to the seasons, in spring and 
in the commencement of summer, children and 
those next to them in age are most comfortable, 
and enjoy best health; in summer and during a 
certain portion of autumn, old people; during 
the remainder of the autumn and in winter, 
those of the intermediate ages. 

19. All diseases occur at all seasons of the year, 
but certain of them are more apt to occur and 
be exacerbated at certain seasons. 

20. The diseases of spring are, maniacal, mel- 
ancholic, and epileptic disorders, bloody flux, 
quinsy, coryza, hoarseness, cough, leprosy, li- 
chen alphos, exanthemata mostly ending in ul- 
cerations, tubercles, and arthritic diseases. 

21. Of summer, certain of these, and contin- 
ued, ardent, and tertian fevers, most especially 
vomiting, diarrhoea, ophthalmy, pains of the 
cars, ulcerations of the mouth, mortifications of 
the privy parts, and the sudamina. 

22. Of autumn, most of the summer, quar- 
tan, and irregular fevers, enlarged spleen, drop- 
sy, phthisis, strangury, lientery, dysentery, sciat- 



ica, quinsy, asthma, ileus, epilepsy, maniacal 
and melancholic disorders. 

23. Of winter, pleurisy, pneumonia, coryza, 
hoarseness, cough, pains of the chest, pains of 
the ribs and loins, headache, vertigo, and apo- 
plexy. 

24. In the different ages the following com- 
plaints occur: to little and new-born children, 
aphthae, vomiting, coughs, sleeplessness, frights, 
inflammation of the navel, watery discharges 
from the ears. 

25. At the approach of dentition, pruritus of 
the gums, fevers, convulsions, diarrhoea, especi- 
ally when cutting the canine teeth, and in those 
who are particularly fat, and have constipated 
bowels. 

26. To persons somewhat older, affections of 
the tonsils, incurvation of the spine at the ver- 
tebra next the occiput, asthma, calculus, round 
worms, ascarides, acrochordon, satyriasmus, 
struma, and other tubercles (phymata)^ but es- 
pecially the aforesaid. 

27. To persons of a more advanced age, and 
now on the verge of manhood, the most of these 
diseases, and, moreover, more chronic fevers, 
and epistaxis. 

28. Young people for the most part have a 
crisis in their complaints, some in forty days, 
some in seven months, some in seven years, 
some at the approach to puberty; and such com- 
plaints of children as remain, and do not pass 
away about puberty, or in females about the 
commencement of menstruation, usually be- 
come chronic. 

29. To persons past boyhood, haemoptysis, 
phthisis, acute fevers, epilepsy, and other dis- 
eases, but especially the aforementioned. 

30. To persons beyond that age, asthma, pleu- 
risy, pneumonia, lethargy, phrenitis, ardent fe- 
vers, chronic diarrhea, cholera, dysentery, lien- 
tery, hemorrhoids. 

31. To old people dyspnoea, catarrhs accom- 
panied with coughs, dysuria, pains of the joints, 
nephritis, vertigo, apoplexy, cachexia, pruritus 
of the whole body, msomnolency, defluxions of 
the bowels, of the eyes, and of the nose, dimness 
of sight, cataract (glaucoma), and dullness of 
hearing. 

SECTION IV 

1. We must purge pregnant women, if mat- 
ters be turgid (in a state of orgasm? ), from the 
fourth to the seventh month, but less freely in 
the latter; in the first and last stages of preg- 
nancy it should be avoided. 

2. In purging we should bring a way such mat- 



Aphorisms 135 

ters from the body as it would be advantageous 
had they come away spontaneously; but those 
of an opposite character should be stopped. 

3. If the matters which are purged be such as 
should be purged, it is beneficial and well borne; 
but if the contrary, with difficulty. 

4. We should rather purge upward in sum- 
mer, and downward in winter. 

5. About the time of the dog-days, and before 
it, the administration of purgatives is unsuit- 
able. 

6. Lean persons who are easily made to vomit 
should be purged upward, avoiding the winter 
season. 

7. Persons who arc difficult to vomit, and are 
moderately fat, should be purged downward, 
avoiding the summer season. 

8. We must be guarded in purging phthisical 
persons upward. 

9. And from the same mode of reasoning, ap- 
plying the opposite rule to melancholic persons, 
we must purge them freely downward. 

10. In very acute diseases, if matters be in a 
state of orgasm, we may purge on the first day, 
for it is a bad thing to procrastinate in such cases. 

ir. Those cases in which there are tormina, 
pains about the umbilicus, and pains about the 
loins, not removed either by purgative medi- 
cines or otherwise, usually terminate in dry 
dropsy. 

12. It is a bad thing to purge upward in win- 
ter persons whose bowels are in a state of lien- 
tery. 

13. Persons who are not easily purged up ward 
by the hellebores, should have their bodies mois- 
tened by plenty of food and rest before taking 
the draught. 

14. When one takes a draught of hellebore, 
one should be made to move more about, and 
indulge less in sleep and repose. Sailing on the 
sea shows that motion disorders the body. 

15. When you wish the hellebore to act more, 
move the body, and when to stop, let the pa- 
tient get sleep and rest. 

1 6. Hellebore is dangerous to persons whose 
flesh is sound, for it induces convulsion. 

17. Anorexia, heartburn, vertigo, and a bit- 
ter taste of the mouth, in a person irce from fe- 
ver, indicate the want of purging upward. 

1 8. Pains seated above the diaphragm indi- 
cate purging upward, and those below it, down- 
ward. 

19. Persons who have no thirst while under 
the action of a purgative medicine, do not cease 
from being purged until they become thirsty. 

20. If persons free from fever be seized with 



136 



Hippocrates 



tormina, heaviness of the knees, and pains of 
the loins, this indicates that purging down ward 
is required. 

21. Alvine dejections which are black, like 
blood, taking place spontaneously, either with 
or without fever, arc very bad; and the more 
numerous and unfavorable the colors, so much 
the worse; when with medicine it is better, and 
a variety of colors in this case is not bad. 

22. When black bile is evacuated in the be- 
ginning of any disease whatever, either up- 
ward or downward, it is a mortal symptom. 

23. In persons attenuated from any disease, 
whether acute or chronic, or from wounds, or 
any other cause, if there be a discharge either of 
black bile, or resembling black blood, they die 
on the following day. 

24. Dysentery, if it commence with black bile, 
is mortal. 

25. Blood discharged upward, whatever be 
its character, is a bad symptom, but downward 
it is (more?) favorable, and so also black de- 
jections. 

26. If in a person ill of dysentery, substances 
resembling flesh be discharged from the bowels, 
it is a mortal symptom. 

27. In whatever cases of fever there is a co- 
pious hemorrhage from whatever channel, the 
bowels are in a loose state during convalescence. 

28. In all cases whatever, bilious discharges 
cease if deafness supervenes, and in all cases 
deafness ceases when bilious discharges super- 
vene. 

29. Rigors which occur on the sixth day have 
a difficult crisis. 

30. Diseases attended with paroxysms, if at 
the same hour that the fever leaves it return 
again next day, are of difficult crisis. 

31. In febrile diseases attended with a sense 
of lassitude, deposits form about the joints, and 
especially those of the jaws. 

32. In convalescents from diseases, if any part 
be pained, there deposits are formed. 

33. But if any part be in a painful state pre- 
vious to the illness, there the disease fixes. 

34. If a person laboring under a fever, with- 
out any swelling in the fauces, be seized with 
a sense of suffocation suddenly, it is a mortal 
symptom. 

35. If in a person affected with fever, the neck 
become suddenly distorted, and he cannot swal- 
low unless with difficulty, although no swelling 
be present, it is a mortal symptom. 

36. Sweats, in febrile diseases, are favorable, 
if they set in on the third, fifth, seventh, ninth, 
eleventh, fourteenth, seventeenth, twenty-first, 



twenty-seventh, and thirty-fourth day, for these 
sweats prove a crisis to the disease; but sweats 
not occurring thus, indicate pain, a protracted 
disease, and relapses. 

37. Cold sweats occurring along with an acute 
fever, indicate death; and along with a milder 
one, a protracted disease. 

38. And in whatever part of the body there is 
a sweat, it shows that the disease is seated there. 

39. And in whatever part of the body heat or 
cold is seated, there is disease. 

40. And wherever there are changes in the 
whole body, and if the body be alternately cold 
and hot, or if one color succeed another, this 
indicates a protracted disease. 

4 1 . A copious sweat after sleep occurring with- 
out any manifest cause, indicates that the body 
is using too much food. But if it occur when 
one is not taking food, it indicates that evacua- 
tion is required. 

42. A copious sweat, whether hot or cold, 
flowingcontinuously, indicates, thecold a great- 
er, and the hot a lesser disease. 

43. Fevers, not of the intermittent type, which 
are exacerbated on the third day, are dangerous; 
but if they intermit in any form, this indicates 
that they are not dangerous. 

44. In cases attended with protracted fevers, 
tubercles (phymata) or pains occur about the 
joints. 

45. When tubercles (phymata) or pains at- 
tack the joints after fevers, such persons are us- 
ing too much food. 

46. If in a fever not of the intermittent type 
a rigor seize a person already much debilitated, 
it is mortal. 

47. In fevers not of the intermittent type, ex- 
pectorations which are livid bloody, fetid and 
bilious, are all bad; but if evacuated properly, 
they are favorable. So it is with the alvine evac- 
uations and the urine. But if none of the proper 
excretions take place by these channels, it is bad. 

48. In fevers not of the intermittent type, if 
the external parts be cold, but the internal be 
burnt up, and if there be thirst, it is a mortal 
symptom. 

49. In a fever not of the intermittent type, if a 
lip, an eye-brow, an eye, or the nose, be distort- 
ed; or if there be loss of sight or of hearing, and 
the patient be in a weak state whatever of 
these symptoms occur, death is at hand. 

50. Apostemes in fevers which are not resolved 
at the first crisis, indicate a protracted disease. 

51. When in a fever not of the intermittent 
type dyspnoea and delirium come on, the case 
is mortal. 



Aphorisms 



137 



52. When persons in fevers, or in other ill- 
nesses, shed tears voluntarily, it is nothing out 
of place; but when they shed tears involuntari- 
ly, it is more so. 

53. In whatever cases of fever very viscid con- 
cretions form about the teeth, the fevers turn 
out to be particularly strong. 

54. In whatever case of ardent fever dry 
coughs of a tickling nature with slight expecto- 
ration are long protracted, there is usually not 
much thirst. 

55. All fevers complicated with buboes arc 
bad, except ephemerals. 

56. Sweat supervening in a caseof fever with- 
out the fever ceasing, is bad, for the disease is 
protracted, and it indicates more copious hu- 
mors. 

57. Fever supervening in a case of confirmed 
spasm, or of tetanus, removes the disease. 

58. A rigor supervening in a case of ardent 
fever, produces resolution of it. 

59. A true tertian comes to a crisis in seven 
periods at furthest. 

60. When in fevers there is deafness, if blood 
run from the nostrils, or the bowels become dis- 
ordered, it carries off the disease. 

61. In a febrile complaint, if the fever do not 
leave on the odd days, it relapses. 

62. When jaundice supervenes in fevers be- 
fore the seventh day, it a bad symptom, unless 
there be watery discharges from the bowels. 

63. In whatever cases of fever rigors occur 
during the day, the fevers come to a resolution 
during the day. 

64. When in cases of fever jaundice occurs on 
the seventh, the ninth, the eleventh, or the four- 
teenth day, it is a good symptom, provided the 
hypochondriac region be not hard. Otherwise 
it is not a good symptom. 

65. A strong heat about the stomach and car- 
dialgia are bad symptoms in fevers. 

66. In acute fevers, spasms, and strong pains 
about the bowels are bad symptoms. 

67. In fevers, frights after sleep, or convul- 
sions, are a bad symptom. 

68. In fevers, a stoppage of the respiration is 
a bad symptom, for it indicates convulsions. 

69. When the urine is thick, grumoss, and 
scanty in cases not free from fever a copious 
discharge of thinner urine proves beneficial. 
Such a discharge more commonly takes place 
when the urine has had a sediment from the 
first, or soon after the commencement. 

70. When in fevers the urine is turbid, like 
that of a beast of burden, in such a case there 
either is or will be headache. 



71. In cases which come to a crisis on the 
seventh day, the urine has a red nubccula on 
the fourth day, and the other symptoms accord- 
ingly. 

72. When the urine is transparent and white, 
it is bad; it appears principally in cases of phre- 
nitis. 

73. When the hypochondriac region is affect- 
ed with meteorism and borborygmi, should 
pain of the loins supervene, the bowels get into 
a loose and watery state, unless there be an erup- 
tion of flatus or a copious evacuation of urine. 
These things occur in fevers. 

74. When there is reason to expect that an 
abscess will form in joints, the abscess is car- 
ried off by a copious discharge of urine, which 
is thick, and becomes white, like what be- 
gins to form in certain cases of quartan fever, 
attended with a sense of lassitude. It is also 
speedily carried off by a hemorrhage from the 
nose. 

75. Blood or pus in the urine indicates ulccra- 
tion either of the kidneys or of the bladder. 

76. When small fleshy substances like hairs 
are discharged along with thick urine, these 
substances come from the kidneys. 

77. In those cases where there are furf uraceous 
particles discharged along with thick urine, 
there is scabies of the bladder. 

78. In those cases where there is a spontane- 
ous discharge of bloody urine, it indicates rup- 
ture of a small vein in the kidneys. 

79. In those cases where there is a sandy sedi- 
ment in the urine, there is calculus in the blad- 
der (or kidneys). 

80. If a patient pass blood and clots in his 
urine, and have strangury, and if a pain seize 
the hypogastric region and perineum, the parts 
about the bladder are affected. 

8 1. If a patient pass blood, pus, and scales, in 
the urine, and if it have a heavy smell, ulcera- 
tion of the bladder is indicated. 

82. When tubercles form in the urethra, if 
these suppurate and burst, there is relief. 

83. When much urine is passed during the 
night, it indicates that the alvine evacuations 
are scanty. 

SECTION V 

1. A spasm from taking hellebore is of a fatal 
nature. 

2. Spasm supervening on a wound is fatal. 

3. A convulsion, or hiccup, supervening on a 
copious discharge of blood is bad. 

4. A convulsion, or hiccup, supervening upon 
hypcrcatharsis is bad. 



z 3 8 

5. If a drunken person suddenly lose his 
speech, he will die convulsed, unless fever come 
on, or he recover his speech at the time when 
the consequences of a debauch pass off. 

6. Such persons as are seized with tetanus die 
within four days, or if they pass these they re- 
cover. 

7. Those cases of epilepsy which come on be- 
fore puberty may undergo a change; but those 
which come on after twenty-five years of age, 
for the most part terminate in death. 

8. In pleuritic affections, when the disease is 
not purged off in fourteen days, it usually ter- 
minates in empycma. 

9. Phthisis most commonly occurs between 
the ages of eighteen and thirty-five years. 

10. Persons who escape an attack of quinsy, 
and when the disease is turned upon the lungs, 
die in seven days; or if they pass these they be- 
come affected with empyema. 

11. In persons affected with phthisis, if the 
sputa which they cough up have a heavy smell 
when poured upon coals, and if the hairs of the 
head fall off, the case will prove fatal. 

12. Phthisical persons, the hairs of whose head 
fall off, die if diarrhoea set in. 

13. In persons who cough up frothy blood, 
the discharge of it comes from the lungs. 

14. Diarrhoea attacking a person affected with 
phthisis is a mortal symptom. 

15. Persons who become affected with empy- 
cma after pleurisy, if they get clear of it in for- 
ty days from the breaking of it, escape the dis- 
ease; but if not, it passes into phthisis. 

1 6. Heat produces the following bad effects 
on those who use it frequently: enervation of 
the fleshy parts, impotence of the nerves, torpor 
of the understanding, hemorrhages, deliquia, 
and, along with these, death. 

17. Cold induces convulsions, tetanus, morti- 
fication, and febrile rigors. 

18. Cold is inimical to the bones, the teeth, 
the nerves, the brain, and the spinal marrow, 
but heat is beneficial. 

19. Such parts as have been congealed should 
be heated, except where there cither is a hem- 
orrhage, or one is expected. 

20. Cold pinches ulcers, hardens the skin, oc- 
casions pain which does not end in suppuration, 
blackens, produces febrile rigors, convulsions, 
and tetanus. 

21. In the case of a muscular youth having 
tetanus without a wound, during the midst of 
summer, it sometimes happens that the affusion 
of a large quantity of cold water recalls the heat. 
Heat relieves these diseases. 



Hippocrates 

22. Heat is suppurative, but not in all kinds 
of sores, but when it is, it furnishes the greatest 
test of their being free from danger. It softens 
the skin, makes it thin, removes pain, soothes 
rigor, convulsions, and tetanus. It removes af- 
fections of the head, and heaviness of it. It is 
particularly efficacious in fractures of the bones, 
especially of those which have been exposed, 
and most especially in wounds of the head, and 
in mortifications and ulcers from cold; in her- 
pes exedens, of the anus, the privy parts, the 
womb, the bladder, in all these cases heat is 
agreeable, and brings matters to a crisis; but 
cold is prejudicial, and does mischief. 

23. Cold water is to be applied in the follow- 
ing cases; when there is a hemorrhage, orwhen 
it is expected, but not applied to the spot, but 
around the spot whence the blood flows; and in 
inflammations and inflammatory affections, in- 
clining to a red and subsaguineous color, and 
consisting of fresh blood, in these cases it is to 
be applied but it occasions mortification in old 
cases; and in erysipelas not attended withulcer- 
ation, as it proves injurious to erysipelas when 
ulcerated. 

24. Cold things, such as snow and ice, are in- 
imical to the chest, being provocative of coughs, 
of discharges of blood, and of catarrhs. 

25. Swellings and pains in the joints,without 
ulceration, those of a gouty nature, and sprains, 
are generally improved by a copious affusion of 
cold water, which reduces the swelling, and re- 
moves the pain; for a moderate degree of numb- 
ness removes pain. 

26. The lightest water is that which is quick- 
ly heated and quickly cooled. 

27. When persons have intense thirst, it is a 
good thing if they can sleep off the desire of 
drinking. 

28. Fumigation with aromatics promotes 
menstruation, and would be useful in many 
other cases, if it did not occasion heaviness of 
the head. 

29. Women in a state of pregnancy may be 
purged, if there be any urgent necessity (or, if 
the humors be in a state of orgasm?), from the 
fourth to the seventh month, but less so in the 
latter case. In the first and last periods it must be 
avoided. 

30. It proves fatal to a woman in a state of 
pregnancy, if she be seized with any of the acute 
diseases. 

31. If a woman with child be bled, she will 
have an abortion, and this will be the more like- 
ly to happen, the larger the foetus. 

32. Haemoptysis in a woman is removed by 



an eruption of the menses. 

33. In a woman when there is a stoppage of 
the menses, a discharge of blood from the nose 
is good. 

34. When a pregnant woman has a violent di- 
arrhoea, there is danger of her miscarrying. 

35. Sneezing occurring to a woman affected 
with hysterics, and in difficult labor, is a good 
symptom. 

36. When the menstrual discharge is of a bad 
color and irregular, it indicates that the woman 
stands in need of purging. 

37. In a pregnant woman, if the breasts sud- 
denly lose their fullness, she has a miscarriage. 

38. If, in a woman pregnant with twins, ei- 
ther of her breasts lose its fullness, she will part 
with one of her children; and if it be the right 
breast which becomes slender, it will be the 
male child, or if the left, the female. 

39. If a woman who is not with child, nor has 
brought forth, have milk, her menses are ob- 
structed. 

40. In women, blood collected in the breasts 
indicates madness. 

41. If you wish to ascertain if a woman be 
with child, give her hydromel to drink when 
she is going to sleep, and has not taken supper, 
and if she be seized with tormina in the belly, 
she is with child, but otherwise she is not preg- 
nant. 

42. A woman with child, if it be a male, has a 
good color, but if a female, she has a bad color. 

43. If erysipelas of the womb seize a woman 
with child, it will probably prove fatal. 

44. Women who are very lean, have miscar- 
riages when they prove with child, until they 
get into better condition. 

45. When women, in a moderate condition 
of body, miscarry in the second or third month, 
without any obvious cause, their cotyledones 
are filled with mucosity, and cannot support 
the weight of the foetus, but are broken asunder. 

46. Such women as a re immoderately fat, and 
do not prove with child, in them it is because the 
epiploon (fat?) blocks up the mouth of the 
womb, and until it be reduced, they do not con- 
ceive. 

47. If the portion of the uterus seated near the 
hip-joint suppurate, it gets into a state requir- 
ing to be treated with tents. 

48. The male foetus is usually seated in the 
right, and the female in the left side. 

49. To procure the expulsion of the secun- 
dines, apply a sternutatory, and shut the nos- 
trils and mouth. 

50. If you wish to stop the menses in a wom- 



Aphorisms 139 

an, apply as large a cupping instrument as pos- 
sible to the breasts. 

51. When women are with child, the mouth 
of their womb is closed. 

52. If in a woman with child, much milk flow 
from the breasts, it indicates that the foetus is 
weak; but if the breasts be firm, it indicates 
that the foetus is in a more healthy state, 

53. In women that are about to miscarry, the 
breasts become slender; but if again they be- 
come hard, there will be pain, either in the 
breasts, or in the hip-joints, or in the eyes, or in 
the knees, and they will not miscarry. 

54. When the mouth of the uterus is hard, 
it is also necessarily shut. 

55. Women with child who are seized with 
fevers, and who are greatly emaciated, without 
any (other?) obvious cause, have difficult and 
dangerous labors, and if they miscarry, they are 
in danger. 

56. In the female flux (immoderate menstru- 
ation?), if convulsion and deliquium come on, 
it is bad. 

57. When the menses are excessive, diseases 
take place, and when the menses are stopped, 
diseases from the uterus take place. 

58. Strangury supervenes upon inflammation 
of the rectum, and of the womb, and strangury 
supervenes upon suppuration of the kidney, and 
hiccup upon inflammation of the liver. 

59. If a woman do not conceive, and wish to 
ascertain whether she can conceive, having 
wrapped her up in blankets, fumigate below, 
and if it appear that the scent passes through 
the body to the nostrils and mouth, know that 
of herself she is not unfruitful. 

60. If woman with a child have her courses, it 
is impossible that the child can be healthy. 

61. If a woman's courses be suppressed, and 
neither rigor nor fever has followed, but she 
has been affected with nausea, you may reckon 
her to be with child. 

62. Women who have the uterus cold and 
dense (compact?) do not conceive; and those al- 
so who have the uterus humid, do not conceive, 
for the semen is extinguished, and in women 
whose uterus is very dry, and very hot, the se- 
men is lost from the want of food; but women 
whose uterus is in an intermediate state be- 
tween these temperaments prove fertile. 

63. And in like manner with respect to males; 
for cither, owing to the laxity of the body, the 
pneuma is dissipated outwardly, so as not to 
propel the semen, or, owing to its density, the 
fluid (semen?) docs not pass outwardly; or, 
owing to coldness, it is not heated so as to col- 



140 



Hippocrates 



lect in its proper place {seminal vessels?), or, 
owing to its heat, the very same thing happens. 

64. It is a bad thing to give milk to persons 
having headache, and it is also bad to give it in 
fevers, and to persons whose hypochondria are 
swelled up, and troubled with borborygmi, and 
to thirsty persons; it is bad also, when given to 
those who have bilious discharges in acute fe- 
vers, and to those who have copious discharges 
of blood; but it is suitable in phthisical cases, 
when not attended with very much fever; it is 
also to be given in fevers of a chronic and weak 
nature, when none of the aforementioned symp- 
toms arc present, and the patients are excessive- 
ly emaciated. 

65. When swellings appear on wounds, such 
cases are not likely to be attacked either with 
convulsions, or delirium, but when these disap- 
pear suddenly, if situated behind, spasms and 
tetanus supervene, and if before, mania, acute 
pains of the sides, or suppurations, or dysen- 
tery, if the swellings be rather red. 

66. When no swelling appears on severe and 
bad wounds, it is a great evil. 

67. In such cases, the soft arc favorable; and 
crude, unfavorable. 

68. When a person is pained in the back part 
of the head, he is benefited by having the straight 
vein in the forehead opened. 

69. Rigors commence in women, especially at 
the loins, and spread by the back to the head; 
and in men also, rather in the posterior than the 
anterior side of the body, as from the arms and 
thighs; the skin there is rare, as is obvious from 
the growth of hair on them. 

70. Persons attacked with quartans are not 
readily attacked with convulsions, or if previ- 
ously attacked with convulsions, they cease if a 
quartan supervene. 

71. In those persons in whom the skin is 
stretched, and parched and hard, the disease ter- 
minates without sweats; but in those in whom 
the skin is loose and rare, it terminates with 
sweats. 

72. Persons disposed to jaundice are not very 
subject to flatulence. 

SECTION VI 

i. In cases of chronic licntery, acid eructations 
supervening when there were none previously, 
is a good symptom. 

a. Persons whose noses are naturally watery, 
ttid their seed watery, have rather a deranged 
state of health; but those in the opposite state, 
a more favorable. 

3. In protracted cases of dysentery, loathing 



of food is a bad symptom, and still worse, if 
along with fever. 

4. Ulcers, attended with a falling off of the 
hair, arc malt moris. 

5. It deserves to be considered whether the 
pains in the sides, and in the breasts, and in the 
other parts, differ much from one another. 

6. Diseases about the kidneys and bladder 
arc cured with difficulty in old men. 

7. Pains occurring about the stomach, the 
more superficial they arc, the more slight arc 
they; and the less superficial, the more severe. 

8. In dropsical persons, ulcers forming on the 
body are not easily healed. 

9. Broad exanthemata are not very itchy. 

10. In a person having a painful spot in the 
head, with intense cephalalgia, pus or water 
running from the nose, or by the mouth, or at 
the ears, removes the disease. 

11. Hemorrhoids appearing in melancholic 
and nephritic affections are favorable. 

12. When a person has been cured of chronic 
hemorrhoids, unless one be left, there is danger 
of dropsy or phthisis supervening. 

13. Sneezing coming on, in the case of a per- 
son afflicted with hiccup, removes the hiccup. 

14. In a case of dropsy, when the water runs 
by the veins into the belly, it removes the dis- 
ease. 

15. In confirmed diarrhoea, vomiting, when 
it comes on spontaneously, removes the diar- 
rhoea. 

16. A diarrhoea supervening in a confirmed 
case of pleurisy or pneumonia is bad. 

17. It is a good thing inophthalmy for the pa- 
tient to be seized with diarrhoea. 

1 8. A severe wound of the bladder, of the 
brain, of the heart, of the diaphragm, of the 
small intestines, of the stomach, and of the liv- 
er, is deadly. 

19. When a bone, cartilage, nerve, the slen- 
der part of the jaw, or prepuce, are cut out, the 
part is neither restored, nor does it unite. 

20. If blood be poured out preternaturally in- 
to a cavity, it must necessarily become cor- 
rupted. 

21. In maniacal affections, if varices or hem- 
orrhoids come on, they remove the mania. 

22. Those ruptures in the back which spread 
down to the elbows are removed by venesec- 
tion. 

23. If a fright or despondency lasts for a long 
time, it is a melancholic affection. 

24. If any of the small intestines be transfixed, 
it docs not unite. 

25. It is not a good sign for an erysipelas 



Aphorisms 



141 



spreading outwardly to be determined inward; 
but for it to be determined outward from with- 
in is good. 

26. In whatever cases of ardent fever tremors 
occur, they are carried off by a delirium. 

27. Those cases of empycma or dropsy which 
are treated by incision or the cautery, if the wa- 
ter or pus flow rapidly all at once, certainly 
prove fatal. 

28. Eunuchs do not take the gout, nor become 
bald. 

29. A woman does not take the gout, unless 
her menses be stopped. 

30. A young man does not take the gout until 
he indulges in coition. 

31. Pains of the eyes are removed by drink- 
ing pure wine, or the bath, or a fomentation, or 
venesection, or purging. 

32. Persons whose speech has become impair- 
ed are likely to be seized with chronic diarrhoea. 

33. Persons having acid eructations are not 
very apt to be seized with pleurisy. 

34. Persons who have become bald arc not 
subject to large varices; but should varices su- 
pervene upon persons who are bald, their hair 
again grows thick. 

35. Hiccup supervening in dropsical cases is 
bad. 

36. Venesection cures dysuria; open the in- 
ternal veins of the arm. 

37. It is a good symptom when swelling on 
the outside of the neck seizes a person very ill 
of quinsy, for the disease is turned outwardly. 

38. It is better not to apply any treatment in 
cases of occult cancer; for, if treated, the pa- 
tients die quickly; but if not treated, they hold 
out for a long time. 

39. Convulsions take place either from reple- 
tion or depletion; and so it is with hiccup. 

40. When pains, without inflammation, oc- 
cur about the hypochondria, in such cases, fever 
supervening removes the pain. 

41. When pus formed anywhere in the body 
does not point, this is owing to the thickness of 
the part. 

42. In cases of jaundice, it is a bad symptom 
when the liver becomes indurated. 

43. When persons having large spleens are 
seized with dysentery, and if the dysentery pass 
into a chronic state, either dropsy or lientery 
supervenes, and they die. 

44. When ileus comes on in a case of stran- 
gury, they prove fatal in seven days, unless, fe- 
ver supervening, there be a copious discharge 
of urine. 

45. When ulcers continue open for a year or 



upward, there must necessarily be exfoliation of 
bone, and the cicatrices are hollow. 

46. Such persons as become hump-backed 
from asthma or cough before puberty, die. 

47. Persons who are benefited by venesection 
or purging, should be bled or purged in spring. 

48. In enlargement of the spleen, it is a good 
symptom when dysentery comes on. 

49. In gouty affections, the inflammation sub- 
sides in the course of forty days. 

50. When the brain is severely wounded, fe- 
ver and vomiting of bile necessarily supervene. 

5 1. When persons in good health are sudden- 
ly seized with pains in the head, and straight- 
way are laid down speechless, and breathe with 
stertor,they die in seven days, unless fever come 
on. 

52. We must attend to the appearances of the 
eyes in sleep, as presented from below; for if a 
portion of the white be seen between the closed 
eyelids, and if this be not connected with diar- 
rhoea or severe purging, it is a very bad and 
mortal symptom. 

53. Delirium attended with laughter is less 
dangerous than delirium attended with a seri- 
ous mood. 

54. In acute diseases, complicated with fever, 
a moaning respiration is bad. 

55. For the most part, gouty affections rankle 
in spring and in autumn. 

56. In melancholic affections, determinations 
of the humor which occasions them produce the 
following diseases; either apoplexy of the whole 
body, or convulsion, or madness, or blindness. 

57. Persons are most subject to apoplexy be- 
tween the ages of forty and sixty. 

58. If the omentum protrude, it necessarily 
mortifies and drops off. 

59. In chronic diseases of the hip-joint, if the 
bone protrude and return again into its socket, 
there is mucosity in the place. 

60. In persons affected with chronic disease 
of the hip-joint, if the bone protrude from its 
socket, the limb becomes wasted and maimed, 
unless the part be cauterized. 

SECTION VII 

1 . In acute diseases, coldness of the extremi- 
ties is bad. 

2. Livid flesh on a diseased bone is bad. 

3. Hiccup and redness of the eyes, when they 
supervene on vomiting, arc bad. 

4. A chill supervening on a sweat is not good. 

5. Dysentery, or dropsy, or ccstacy coming 
on madness is good. 

6. In a very protracted disease, loss of appetite 



141 Hippocrates 

and unmixed discharges from the bowels are 
bad symptoms. 

7. A rigor and delirium from excessive drink- 
ing are bad. 

8. From the rupture of an internal abscess, 
prostration of strength, vomiting, and deliqu- 
ium animi result. 

9. Delirium or convulsion from a flow of blood 
is bad. 

10. Vomiting,or hiccup, or convulsion, or de- 
lirium, in ileus, is bad. 

11. Pneumonia coming on pleurisy is bad. 

12. Phrenitis along with pneumonia is bad. 

13. Convulsion or tetanus, coming upon se- 
vere burning, is bad. 

14. Stupor or delirium from a blow on the 
head is bad. 

15. From a spitting of blood there is a spit- 
ting of pus. 

16. From spitting of pus arise phthisis and a 
flux; and when the sputa are stopped, they die. 

17. Hiccup in inflammationof the liver is bad. 

18. Convulsion or delirium supervening up- 
on insomnolency is bad. 

1 8#. Trembling upon lethargus is bad. 

19. Erysipelas upon exposure of a bone (is 
bad?). 

20. Mortification or suppuration upon erysip- 
elas is bad. 

21. Hemorrhage upon a strong pulsation in 
wounds is bad. 

22. Suppuration upon a protracted pain of the 
parts about the bowels is bad. 

23. Dysentery upon unmixed alvine dis- 
charges is bad. 

24. Delirium upon division of the cranium, if 
it penetrate into the cavity of the head, is bad. 

25. Convulsion upon severe purging is mortal. 

26. Upon severe pain of the parts about the 
bowels, coldness of the extremities coming on 
is bad. 

27. Tcncsmus coming on in a case of preg- 
nancy causes abortion. 

28. Whatever piece of bone, cartilage, or 
nerve (tendon?) is cut off, it neither grows nor 
unites. 

29. When strong diarrhoea supervenes in a 
case of leucophlegmatia, it removes the disease. 

30. In those cases in which frothy discharges 
occur in diarrhoea there are defluxions from the 
head. 

31. When there is a farinaceous sediment in 
the urine during fever, it indicates a protracted 
illness. 

32. In those cases in which the urine is thin 
at first, and the sediments become bilious, 



an acute disease is indicated. 

33. In those cases in which the urine becomes 
divided there is great disorder in the body. 

34. When bubbles settle on the surface of the 
urine, they indicate disease of the kidneys, and 
that the complaint will be protracted. 

35. When the scum on the surface is fatty and 
copious, it indicates acute diseases of the kid- 
neys. 

36. Whenever the aforementioned symptoms 
occur in nephritic diseases, and along with them 
acute pains about the muscles of the back, pro- 
vided these be seated about the external parts, 
you may expect that there will be an abscess; 
but if the pains be rather about the internal 
parts, you may also rather expect that the ab- 
scess will be seated internally. 

37. Harmatemesis, without fever, does not 
prove fatal, but with fever it is bad; it is to be 
treated with refrigerant and styptic things. 

38. Defluxions into the cavity of the chest sup- 
purate in twenty days. 

39. When a patient passes blood and clots, 
and is seized with strangury and pain in the 
perineum and pubes, disease about the bladder 
is indicated. 

40. If the tongue suddenly lose its powers, or 
a part of the body become apoplectic, the af- 
fection is of a melancholic nature. 

41. In hypercatharsis, of old persons, hiccup 
supervening is not a good symptom. 

42. In a fever, which is not of a bilious nature, 
a copious affusion of hot water upon the head 
removes the fever. 

43. A woman does not become ambidexter- 
ous. 

44. When empyema is treated either by the 
cautery or incision, if pure and white pus flow 
from the wound, the patients recover; but if 
mixed with blood, slimy and fetid, they die. 

45. When abscess of the liver is treated by the 
cautery or incision, if the pus which is discharged 
be pure and white, the patients recover, (for in 
this case it is situated in the coats of the liver;) 
but if it resemble the lees of oil as it flows, they 
die. 

46. Pains of the eyes are removed by drink- 
ing undiluted wine, plenteous bathing with hot 
water, and venesection. 

47. If a dropsical patient be seized with hic- 
cup the case is hopeless. 

48. Strangury and dysuria are cured by drink- 
ing pure wine, and ve/iesection; open the vein 
on the inside. 

49. It is a good sign when swelling and red- 
ness on the breast seize a person very ill of 



Aphorisms 



quinsy, for in this case the disease is diverted 
outwardly. 

50. When the brain is attacked with sphacelus, 
the patients die in three days; or if they escape 
these, they recover. 

51. Sneezing arises from the head, owing to 
the brain being heated, or the cavity (ventricle) 
in the head being filled with humors; the air 
confined in it then is discharged, and makes a 
noise, because it comes through a narrow pas- 
sage. 

52. Fever supervening on painful affections 
of the liver removes the pain. 

53. Those persons to whom it is beneficial to 
have blood taken from their veins, should have 
it done in spring. 

54. In those cases where phlegm is collected 
between the diaphragm and the stomach, and 
occasions pain, as not finding a passage into ei- 
ther of the cavities, the disease will be carried 
off if the phlegm be diverted to the bladder by 
the veins. 

55. When the liver is filled with water and 
bursts into the epiploon, in this case the belly 
is filled with water and the patient dies. 

56. Anxiety, yawning, rigor, wine drunk 
with an equal proportion of water, removes these 
complaints. 

57. When tubercles (phymata) form in the 
urethra, if they suppurate and burst, the pain 
is carried off. 

58. In cases of concussion of the brain pro- 
duced by any cause, the patients necessarily lose 
their speech. 

59. In a person affected with fever, when there 
is no swelling in the fauces, should suffocation 
suddenly come on, and the patient not be able 
to swallow, except with difficulty, it is a mortal 
symptom. 

59<*. In the case of a person oppressed by fe- 
ver, if the neck be turned aside, and the patient 
cannot swallow, while there is no swelling in 
the neck, it is a mortal sign. 

60. Fasting should be prescribed for those per- 
sons who have humid flesh; for fasting dries 
bodies. 

6i.-When there are changes in the whole 
body, and the body becomes sometimes cold 
and sometimes hot, and the color changes, a 
protracted disease is indicated. 

62. A copious sweat, hot or cold, constantly 
flowing, indicates a superabundance of humid- 
ity; we must evacuate then, in a strong person 
upward, and in a weak, downward. 

63. Fevers, not of the intermittent type, if 
they become exacerbated every third day arc 



dangerous; but if they intermit in any form 
whatever, this shows that they arc not danger- 
ous. 

64-In cases of protracted fever, either chronic 
abscesses or pains in the joints come on. 

65. When chronic abscesses (phymata) or 
pains in the joints take place after fevers, the 
patients are using too much food. 

66. If one give to a person in fever the same 
food which is given to a person in good health, 
what is strength to the one is disease to the 
other. 

67. We must look to the urinary evacuations, 
whether they resemble those of persons in health; 
if not at all so, they are particularly morbid, but 
if they are like those of healthy persons, they 
are not at all morbid. 

68. When the dejections are allowed to stand 
and not shaken, and a sediment is formed like 
scrapings (of the bowels), in such a case it is 
proper to purge the bowels; and if you give 
ptisans before purging, the more you give the 
more harm you will do. 

69. Crude dejections are the product of black 
bile; if abundant, of more copious, and if de- 
ficient, of less copious collections of it. 

70. The sputa in fevers, not of an intermit- 
tent type, which are livid, streaked with blood, 
and fetid, are all bad, it is favorable when this 
evacuation, like the urinary and alvine, passes 
freely; and whenever any discharge is suppres- 
sed and not purged off it is bad. 

71. When you wish to purge the body, you 
must bring it into a state favorable to evacu- 
ations; and if you wish to dispose it to evacu- 
ations upward, you must bind the belly; and if 
you wish to dispose it to evacuations down- 
ward, you must moisten the belly. 

72. Sleep and watchfulness, both of them, 
when immoderate, constitute disease. 

73. In fevers which do not intermit, if the ex- 
ternal parts be cold, and the internal burning 
hot, and fever prevail, it is a mortal sign. 

74. In a fever which does not intermit, if a 
lip, the nose, or an eye be distorted, if the pa- 
tient lose his sense of sight or of hearing, while 
now in a weak state, whatever of these symp- 
toms occurs it is mortal. 

75. Upon leucophlegmatia dropsy supervenes. 

76. Upon diarrhoea dysentery. 

77. Upon dysentery licntery. 

78. Upon sphacelus exfoliation of the bone. 

79 and 80. Upon vomiting of blood consump- 
tion, and a purging of pus upward; upon con- 
sumption a defluxion from the head; upon a de- 
fluxion diarrhoea; upon diarrhoea a stoppage of 



144 



Hippocrates 



the purging upward; upon the stoppage of it 
death. 

8 1. In the discharges by the bladder, the bel- 
ly, and the flesh (the styn?) if the body has de- 
parted slightly from its natural condition, the 
disease is slight; if much, it is great; if very 
much, it is mortal. 

82. Persons above forty years of age who are 
affected with frenzy, do not readily recover; the 
danger is less when the disease is cognate to the 
constitution and age. 

83. In whatever diseases the eyes weep vol- 
untarily, it is a good symptom, but when invol- 
untarily, it is a bad. 

84. When in quartan fevers blood flows from 



the nostrils it is a bad symptom. 

85. Sweats are dangerous when they do not 
occur on critical days, when they arc strong, and 
quickly forced out of the forehead, either in the 
form of drops or in streams, and if excessively 
cold and copious; for such a sweat must proceed 
from violence, excess of pain, and prolonged 
squeezing (affliction?). 

86. In a chronic disease an excessive flux from 
the bowels is bad. 

87. Those diseases which medicines do not 
cure, iron (the tyije?) cures; those which iron 
cannot cure, fire cures; and those which fire 
cannot cure, are to be reckoned wholly incur- 
able. 



The Law 



MEDICINE is of all the Arts the most noble; 
but, owing to the ignorance of those who prac- 
tice it, and of those who, inconsiderately, form 
a judgment of them, it is at present far behind 
all theotherarts. Their mistake appears tome to 
arise principally from this, that in the cities 
there is no punishment connected with the prac- 
tice of medicine (and with it alone) except dis- 
grace, and that does not hurt those who are 
familiar with it. Such persons are like the fig- 
ures which are introduced in tragedies, for as 
they have the shape, and dress, and personal 
appearance of an actor, but are not actors, so 
also physicians are many in title but very few 
in reality. 

2. Whoever is to acquire a competent knowl- 
edge of medicine, ought to be possessed of the 
following advantages: a natural disposition; in- 
struction; a favorable position for the study; 
early tuition; love of labor; leisure. First of 
all, a natural talent is required; for, when Na- 
ture opposes, everything else is in vain; but 
when Nature leads the way to what is most ex- 
cellent, instruction in the art takes place, which 
the student must try to appropriate to himself 
by reflection, becoming an early pupil in a place 
well adapted for instruction. He must also bring 
to the task a love of labor and perseverance, so 
that the instruction taking root may bring forth 
proper and abundant fruits. 



3. Instruction in medicine is like the culture 
of the productions of the earth. For our natural 
disposition is, as it were, the soil; the tenets of 
our teacher are, as it were, the seed; instruction 
in youth is like the planting of the seed in the 
ground at the proper season; the place where 
the instruction is communicated is like the food 
imparted to vegetables by the atmosphere; dili- 
gent study is like the cultivation of the fields; 
and it is time which imparts strength to all 
things and brings them to maturity. 

4. Having brought all these requisites to the 
study of medicine, and having acquired a true 
knowledge of it, we shall thus, in traveling 
through the cities, be esteemed physicians not 
only in name but in reality. But inexperience is 
a bad treasure, and a bad fund to those who 
possess it, whether in opinion or reality, being 
devoid of self-reliance and contentedness, and 
the nurse both of timidity and audacity. For 
timidity betrays a want of powers, and audacity 
a want of skill. There are, indeed, two things, 
knowledge and opinion, of which the one makes 
its possessor really to know, the other to be igno- 
rant. 

5. Those things which are sacred, are to be 
imparted only to sacred persons; and it is not 
lawful to import them to the profane until 
they have been initiated in the mysteries of 
the science. 



On Ulcers 



WE MUST avoid wetting all sorts of ulcers 
except with wine, unless the ulcer be situated 
in a joint. For, the dry is nearer to the sound, 
and the wet to the unsound, since an ulcer is 
wet, but a sound part is dry. And it is better to 
leave the part without a bandage unless a cata- 
plasm be applied. Neither do certain ulcers ad- 
mit of cataplasms, and this is the case with the 
recent rather than the old, and with those situ- 
ated in joints. A spare diet and water agree with 
all ulcers, and with the more recent rather than 
the older; and with an ulcer which either is in- 
flamed or is about to be so; and where there is 
danger of gangrene; and with the ulcers an in- 
flammation in joints; and where there is dan- 
ger of convulsion; and in wounds of the belly; 
but most especially in fractures of the head and 
thigh, or any other member in which a fracture 
may have occurred. In the case of an ulcer, it is 
not expedient to stand; more especially if the 
ulcer be situated in the leg; but neither, also, 
is it proper to sit or walk. But quiet and rest are 
particularly expedient. Recent ulcers, both the 
ulcers themselves and the surrounding parts, 
will be least exposed to inflammation, if one 
shall bring them to a suppuration as expedi- 
tiously as possible, and if the matter is not pre- 
vented from escaping by the mouth of the sore; 
or, if one should restrain the suppuration, so 
that only a small and necessary quantity of pus 
may be formed, and the sore may be kept dry 
by a medicine which does not create irritation. 
For the part becomes inflamed when rigor and 
throbbing supervene; for ulcers then get in- 
flamed when suppuration is about to form. A 
sore suppurates when the blood is changed and 
becomes heated; so that becoming putrid, it 
constitutes the pus of such ulcers. When you 
seem to require a cataplasm, it is not the ulcer 
itself to which you must apply the cataplasm, 
but to the surrounding parts, so that the pus 
may escape and the hardened parts may become 
soft. Ulcers formed either from the parts hav- 
ing been cut through by a sharp instrument, 
or excised, admit of medicaments for bloody 
wounds ('eVcu/Aa), and which will prevent sup- 
puration by being desiccant to a certain degree. 
But, when the flesh has been contused and 
roughly cut by the weapon, it is to be so treated 
that it may suppurate as quickly as possible; 
for thus the inflammation is less, and it is neces- 
sary that the pieces of flesh which arc bruised 
and cut should melt away by becoming putrid, 



being converted into pus, and that new flesh 
should then grow up. In every recent ulcer, ex- 
cept in the belly, it is expedient to cause blood 
to flow from it abundantly, and as may seem 
seasonable; for thus will the wound and the 
adjacent parts be less attacked with inflamma- 
tion. And, in like manner, from old ulcers, 
especially if situated in the leg, in a toe or fin- 
ger, more than in any other part of the body. 
For when the blood flows they become drier 
and less in size, as being thus dried up. It is this 
(the blood?) especially which prevents such 
ulcers from healing, by getting into a state of 
putrefaction and corruption. But, it is expedi- 
ent, after the flow of the blood, to bind over the 
ulcer a thick and soft piece of sponge, rather 
dry than wet, and to place above the sponge 
some slender leaves. Oil, and all things of an 
emollient and oily nature, disagree with such ul- 
cers, unless they are getting nearly well. Neither 
does oil agree with wounds which have been 
recently inflicted, nor yet do medicines formed 
with oil or suet, more especially if the ulcer 
stands in need of more cleansing. And, in a 
word, it is in summer and in winter that we arc 
to smear with oil these sores that require such 
medicines. 

2. Gentle purging of the bowels agrees with 
most ulcers, and in wounds of the head, belly, 
or joints, where there is danger of gangrene, in 
such as require sutures, in phagedaenic, spread- 
ing and in otherwise inveterate ulcers. And 
when you want to apply a bandage, no plasters 
are to be used until you have rendered the sore 
dry, and then indeed you may apply them. The 
ulcer is to be frequently cleaned with a sponge, 
and then a dry and clean piece of cloth is to be 
frequently applied to it, and in this way the 
medicine which it is supposed will agree with 
it is to be applied, either with or without a band- 
age. The hot season agrees better than winter 
with most ulcers, except those situated in the 
head and belly; but the equinoctial season agrees 
still better with them. Ulcers which have been 
properly cleansed and dried as they should be, 
do not usually get into a fungated state. When 
a bone has exfoliated, or has been burned, or 
sawed, or removed in any other way, the cica- 
trices of such ulcers become deeper than usual. 
Ulcers which arc not cleansed, arc not disposed 
to unite if brought together, nor do the lips 
thereof approximate of their own accord. When 
the points adjoining to an ulcer are inflamed, 



145 



146 



Hippocrates 



the ulcer is ^ot disposed to heal until the in- 
flammation subside, nor when the surrounding 
parts are blackened by mortification, nor when 
a varix occasions an overflow of blood in the 
part, is the ulcer disposed to heal, unless you 
bring the surrounding parts into a healthy con- 
dition. 

3. Circular ulcers, if somewhat hollow, you 
must scarify all along their edges, or to the ex- 
tent of half the circle, according to the natural 
stature of the man. When erysipelas supervenes 
upon any sore, you must purge the body, in the 
way most suitable to the ulcer, either upward 
or downward. When swelling arises around an 
ulcer, and if the ulcer remain free from inflam- 
mation, there will be a deposit of matter in proc- 
ess of time. And whatever ulcer gets swelled 
along with inflammation and does not subside 
as the other parts subside which became in- 
flamed and swelled at the same time, there is a 
danger that such an ulcer may not unite. When 
from a fall, or in any other way, a part has been 
torn or bruised, and the parts surrounding the 
ulcer have become swelled, and, having sup- 
purated, matter flows from the swelling by the 
ulcer, if in such cases a cataplasm be required, 
it should not be applied to the sore itself, but to 
the surrounding parts, so that the pus may have 
free exit, and the indurated parts may be sof- 
tened. But when the parts are softened as the in- 
flammation ceases, then the parts which are sep- 
arated are to be brought toward one another, 
binding on sponges and applying them, begin- 
ning from the sound parts and advancing to 
the ulcer by degrees. But plenty of leaves are to 
be bound above the sponge. When the parts are 
prevented from coming together by a piece of 
flesh full of humors, it is to be removed. When 
the ulcer is deep seated in the flesh, it is swelled 
up, both from the bandaging and the compres- 
sion. Such an ulcer should be cut up upon a di- 
rector (specillum) if possible, at the proper 
time, so as to admit a free discharge of the mat- 
ter, and then the proper treatment is to be ap- 
plied as may be needed. For the most part, in 
every hollow ulcer which can be seen into di- 
rect without any swelling being present, if there 
be putrefaction in it, or if the flesh be flabby 
and putrid, such an ulcer, and the parts which 
surround it, will be seen to be black and some- 
what livid. And of corroding ulcers, those which 
are phagedsenic, spread and corrode most pow- 
erfully, and, in this case, the parts surrounding 
the sore will have a black and sub-livid appear- 
ance. 

4. Cataplasms for swellings and inflamma- 



tion in the surrounding parts. Boiled mullein, 
the raw leaves of the trefoil, and the boiled 
leaves of the epipetrum, and the poley, and if 
the ulcer stand in need of cleansing, all these 
things also cleanse; and likewise the leaves of 
the fig-tree, and of the olive, and the horehound, 
all these are to be boiled; and more especially 
the chaste-tree, and the fig, and the olive, and 
the leaves of the pomegranate are to be boiled 
in like manner. These are to be used raw: and 
the leaves of the mallow pounded with wine, 
and the leaves of rue, and those of the green 
origany. With all these, linseed is to be boiled 
up and mixed by pounding it as a very fine 
powder. When there is danger of erysipelas 
seizing the ulcers, the leaves of woad are to be 
pounded and applied raw in a cataplasm along 
with linseed, or the linseed is to be moistened 
with the juice of strychnos or of woad, and ap- 
plied as a cataplasm. When the ulcer is clean, 
but both it and the surrounding parts are in- 
flamed, lentil is to be boiled in wine and finely 
triturated, and, being mixed with a little oil, it 
is to be applied as a cataplasm; and the leaves 
of the hip-tree are to be boiled in water and 
pounded in a fine powder and made into a 
cataplasm; and apply below a thin, clean piece 
of cloth wetted in wine and oil; and when you 
wish to produce contraction, prepare the leaves 
of the hip-tree like the lentil, and thecress; wine 
and finely-powdered linseed are to be mixed to- 
gether. And this is proper: linseed, and raw 
chaste-tree, and Melian alum, all these things 
being macerated in vinegar. 

5. Having pounded the white unripe grape 
in a mortar of red bronze, and passed it through 
the strainer, expose it to the sun during the day, 
but remove it during the night, that it may not 
suffer from the dew; rub it constantly during 
the day, so that it may dry equally, and may 
contract as much virtue as possible from the 
bronze: let it be exposed to the sun for as great 
a length of time as till it acquire the thickness 
of honey; then put it into a bronze pot with the 
fresh honey and sweet wine, in which turpen- 
tine resin has been previously boiled, boil the 
resin in the wine until it become hard like 
boiled honey; then take out the resin and pour 
off the wine: there should be the greatest pro- 
portion of the juice of unripe grape, next of the 
wine, and third of the honey and myrrh, either 
the liquid (stacte) or otherwise. The finest kind 
is to be levigated and moistened by having a 
small quantity of the same wine poured on it; 
and then the myrrh is to be boiled by itself, 
stirring it in the wine; and when it appears to 



On Ulcers 



have attained the proper degree of thickness, 
it is to be poured into the juice of the unripe 
grape; and the finest natron is to be toasted) and 
gently added to the medicine, along with a 
smaller quantity of the flowers of copper (flos 
arts) than of the natron. When you have mixed 
these things, boil for not less than three days, 
on a gentle fire made with fuel of the fig-tree or 
with coals, lest it catch fire. The applications 
should all be free from moisture, and the sores 
should not be wetted when this medicine is ap- 
plied in the form of liniment. This medicine is 
to be used for old ulcers, and also for recent 
wounds of the glans penis, and ulcers on the 
head and ears. Another medicine for the same 
ulcers: The dried gall of an ox, the finest 
honey, white wine, in which the shavings of 
the lotus have been boiled, frankincense, of 
myrrh an equal part, of saffron an equal part, 
the flowers of copper, in like manner of liquids, 
the greatest proportion of wine, next of honey, 
and least of the gall. Another: Wine, a little 
cedar honey, of dried things, the flowers of cop- 
per, myrrh, dried pomegranate rind. Another: 
Of the roasted flower of copper half a drachm, 
of myrrh two half-drachms, of saffron three 
drachms, of honey a small quantity, to be 
boiled with wine. Another: Of frankincense 
a drachm, of gall a drachm, of saffron three 
drachms; let each of these be dried and finely 
levigated, then, having mixed, triturate in a 
very strong sun, pouring in the juice of an un- 
ripe grape, until it become of a gelatinous con- 
sistence, for three days; then let them be allow- 
ed to macerate in an austere, dark-colored, 
fragrant wine, which is gradually poured upon 
them. Another: Boil the roots of the holm- 
oak in sweet white wine; and when it appears 
to be properly done, having poured off two 
parts of the wine, and of the lees of wine as free 
of water as possible one part; then boil, stirring 
it, so that it may not be burnt, at a gentle fire, 
until it appear to have attained the proper con- 
sistence. Another: The other things are to be 
the same; but, instead of the wine, use the 
strongest white vinegar, and dip into it wool as 
greasy as can be procured, and then, moisten- 
ing it with the lees of oil, boil, and pour in the 
juice of the wild fig-tree, and add Melian alum, 
and natron, and the flowers of copper, both 
toasted. This cleanses the ulcers better than 
the former, but the other is no less desiccant. 
Another: Dip the wool in a very little water; 
and then, having added a third part of wine, 
boil until it attain the proper consistence. By 
these, recent ulcers are most speedily prevented 



from getting into a state of suppuration. 

6. Another: Sprinkle on it dried wakcrobin, 
and add the green bark of the fig-tree, pound- 
ing it in the juice: do this with or without wine, 
and along with honey. Another: Boiling the 
shavings of lotus with vinegar (the vinegar 
should be white); then mix the lees of oil and 
raw tar-water, and use it as a liniment or wash, 
and bandage above. These things in powder 
prevent recent wounds from suppurating, or 
they may be used for cleansing the sore along 
with vinegar, or for sponging with wine. 

7. Another: Sprinkle (on the sore?) lead 
finely triturated with the recrement of copper; 
and sprinkle on it, also, the shavings of lotus, 
and the scales of copper, and alum, and chalcitis, 
with copper, both alone, and with the shavings 
of lotus. And otherwise, when it is wanted to 
use these in a dry state, do it with the Illyrian 
spodos triturated with the shavings, and with 
the shavings alone. And the flowers of silver 
alone, in the finest powder; and birthwort, 
when scraped and finely pounded, may be sprin- 
kled on the part. Another, for bloody sores 
myrrh, frankincense, galls, verdigris the roasted 
flower of copper, Egyptian alum roasted, vine 
flowers, grease of wool, plumbago, each of these 
things is to be diluted, in equal proportions, with 
wine like the former. And there is another prep- 
aration of the same: The strongest vinegar 
of a white color, honey, Egyptian alum, the 
finest natron; having toasted these things gent- 
ly, pour in a little gall; this cleanses fungous 
ulcers, renders them hollow, and is not pun- 
gent. Another: The herb with the small leaves, 
which gets the name of Parthenium parviflor- 
um, and is used for removing thymia (warts} ) 
from the glans penis, alum, chalcitis, a little 
crude Melian alum (?); sprinkle a little dried 
elaterium, and a little dried pomegranate rind 
in like manner. 

8. The herb which has got the name of la- 
gopyrus, fills up hollow and clean ulcers; (when 
dried it resembles wheat; it has a small leaf like 
that of the olive, and more long;) and the leaf 
of horehound, with oil. Another: The internal 
fatty part, resembling honey, of a fig much 
dried, of water two parts, of linseed not much 
toasted and finely levigated, one part. Another: 
Of the dried fig, of the flower of copper levi- 
gated a little, and the juice of the fig. The prep- 
aration from dried fig: The black chamaeleon, 
the dried gall of an ox, the other things the 
same. Of the powders: Of the slender cress in 
a raw state, of horehound, of each equal parts; 
of the dried fig, two parts; of linseed, two parts; 



148 



Hippocrates 



the juice of the fig. When you use any of these 
medicines, apply above it compresses wetted 
in vinegar, apply a sponge about the compresses 
and^makca little more pressure. If the surround- 
ing'parts be in an inflamed state, apply to them 
any medicine which may appear suitable. 

9. If you wish to use a liquid application, the 
medicine called cancum may be rubbed in, and 
the bandages may be applied as formerly de- 
scribed upon the same principle. The medicine 
is prepared of the following ingredients: Of 
black hellebore, of sandarach, of the flakes of 
copper, of lead washed, with much sulphur, ar- 
senic, and cantharidcs.This may be compound- 
ed so as may be judged most proper, and it is 
to be diluted with oil of juniper. When enough 
has been rubbed in, lay aside the medicine, and 
apply boiled wakerobin in a soft state, either 
rubbing it in dry, or moistening it with honey. 
But if you use the caricum in a dry state, you 
must abstain from these things, and sprinkle 
the medicine on the sore. The powder from 
hellebore and sandarach alone answers. Anoth- 
er liquid medicine: The herb, the leaf of 
which resembles the arum (wakerobin) in na- 
ture, but is white, downy, of the size of the 
ivy-leaf: this herb is applied with wine, or the 
substance which forms upon the branches of 
the ilex, when pounded with wine, is to be ap- 
plied. Another: The juice of theunripe grape, 
the strongest vinegar, the flower of copper, 
natron, the juice of the wild fig-tree. Alum, the 
most finely levigated, is to be put into the juice 
of the wild grape, and it is to be put into a red 
bronze mortar and stirred in the sun, and re- 
moved when it appears to have attained its prop- 
er consistence. 

10. These arc other powders: Black helle- 
bore, as finely levigated as possible, is to be 
sprinkled on the sore while any humidity re- 
mains about it, and while it continues to spread. 
The bandaging is the same as when plasters 
arc used. Another, in like manner: The driest 
lumps of salt arc to be put into a copper, or 
earthen pot, of equal size, as much as possible, 
and not large, and the finest honey, of double 
the size of the salt, as far as can be guessed, is 
to be poured upon the lumps of salt, then the 
vessel is to be put upon coals and allowed to 
sit there until the whole is consumed. Then, 
having sponged the ulcer and cleansed it, band- 
age it as before, and compress it a little more. 
Next day, wherever the medicine has not been 
taken in, sprinkle it on, press it down, and band- 
age. But when you wish to remove the medi- 
cine, pour in hot vinegar until it separate, and 



again do the same things, sponging it away, if 
necessary. Another corrosive powder: Of the 
most finely-levigated misy, sprinkle upon the 
moist and gangrenous parts, and a little of the 
flower of copper, not altogether levigated. 
Another powder equally corrosive: Having 
sponged the ulcer, burn the most greasy wool 
upon a shell placed on the fire until the whole 
be consumed; having reduced this to a fine 
powder, and sprinkled it on the sore, apply the 
bandage in the same manner. Another powder 
for the same ulcers: The black chamadeon, 
when prepared with the juice of the fig. It is 
to be prepared roasted, and alkanet mixed with 
it. Or, pimpernel, and Egyptian alum roasted, 
and sprinkle on them the Orchomenian powder. 
For spreading ulcers: Alum, both the Egyp- 
tian roasted, and the Melian; but the part is 
to be first cleansed with roasted natron and 
sponged; and the species of alum called chal- 
citis roasted. It is to be roasted until it catch 
fire. 

11. For old ulcers which occur on the fore 
part of the legs; they become bloody and black: 
Having pounded the flower of themelilot and 
mixed it with honey, use as a plaster. For 
nerves (tendons?) which have been cut asun- 
der: Having pounded, sifted, and mixed with 
oil the roots of the wild myrtle, bind on the 
part; and the herb cinquefoil (it is white and 
downy, and more raised above the ground than 
the black cinquefoil), having pounded this herb 
in oil bind it on the part, and then remove it 
on the third day. 

12. Emollients (?) : These medicines are to 
be used in winter rather than in summer. Emol- 
lient medicines which make the cicatrices fair: 
Pound the inner mucous part of the squill 
and pitch, with fresh swine's seam, and a little 
oil, and a little resin, and ceruse. And the grease 
of a goose, fresh swine's seam, and squill, and a 
little oil. The whitest wax, fresh clean grease, or 
squill and white oil, and a little resin. Wax, 
swine's seam (old and fresh), and oil, and ver- 
digris, and squill and resin. Let there be two 
parts of the old grease to the fresh, and of the 
other things, q. s. Having melted the grease that 
is fresh, pour it into another pot; having levi- 
gated plumbago finely and sifted it, and mixed 
them together, boil and stir at first; boil until 
when poured upon the ground it concretes; 
then taking it off the fire, pour it all into another 
vessel, with the exception of the stony sediment, 
and add resin and stir, and mix a little oil of 
juniper, and what has been taken off. In all the 
emollient medicines to which you add the resin, 



On Ulcers 



149 



when you remove the medicine from the fire, 
pour in and mix the resin while it is still warm. 
Another: Old swine's seam, wax, and oil, the 
dried shavings of the lotus, frankincense, plum- 
bago, namely, of the frankincense one part, 
and of the other one part, and of the shavings 
of the lotus one part; but let there be two parts 
of the old grease, one of wax, and of fresh 
swine's seam one part. Another : Or old swine's 
seam along with the fresh grease of a goat; 
when cleaned, let it retain as little as possible 
of its membrane: having triturated or pounded 
it smooth, pour in oil, and sprinkle the lead 
with the spodium and half the shavings of the 
lotus. Another: Swine's seam, spodium, blue 
chalcitis, oil. 

13. For Burns: You must boil the tender 
roots of the ilex, and if their bark be very thick 
and green, it must be cut into small parts, and 
having poured in white wine, boil upon a gen- 
tle fire, until it appear to you to be of the proper 
consistence, so as to be used for a liniment. And 
it may be prepared in water after the same man- 
ner. Another, not corrosive: Old swine's seam 
is to be rubbed in by itself, and it is to be melted 
along with squill, the root of which is to be 
divided and applied with a bandage. Next day 
it is to be fomented; and having melted old 
swine's seam and wax, and mixed with them oil, 
frankincense, and the shavings of lotus and ver- 
milion, this is to be used as a liniment. Having 
boiled the leaves of the wakerobin in wine and 
oil, apply a bandage. Another: When you have 
smeared the parts with old swine's seam let 
the roots of asphodel be pounded in wine and 
triturated, and rubbed in. Another: Having 
melted old swine's seam, and mixed with resin 
and bitumen, and having spread it on a piece 
of cloth and warmed it at the fire, apply a band- 
age. When an ulcer has formed on the back 
from stripes or otherwise, let squill, twice boil- 
ed, be pounded and spread upon a linen cloth 
and bound on the place. Afterward the grease 
of a goat, and fresh swine's beam, spodium, oil, 
and frankincense are to be rubbed in. 

14. Swellings which arise on the feet, either 
spontaneously or otherwise, when neither the 
swellings nor the inflammation subside under 
the use of cataplasms, and although sponges or 
wool, or any thing else be bound upon the sound 
part; but the swelling and inflammation return 
of themselves again, an influx of blood into the 
veins is the cause, when not occasioned by a 
bruise. And the same story applies if this hap- 
pen in any other part of the body. But blood is 
to be abstracted, especially from the veins, which 



are the seat of the influx, if they be conspicuous; 
but if not, deeper and more numerous scarifica- 
tions are to be made in the swellings; and what- 
ever part you scarify, this is to be done with 
the sharpest and most slender instruments of 
iron. When you have removed the blood, you 
must not press hard upon the part with the 
specillum, lest you produce contusion. Bathe 
with vinegar, and do not allow a clot of blood 
to remain between the lips of the wounds, and 
having spread greasy wool with a medicine for 
bloody wounds, and having carded the woof 
and made it soft, bind it on, having wetted it 
with wine and oil. And let the scarified part be 
so placed that the determination of the blood 
may be upward and not downward; and do not 
wet the part at all, and let the patient be put up- 
on a restricted diet and drink water. If upon 
loosing the bandages you find the scarifications 
inflamed, apply a cataplasm of the fruit of the 
chaste-tree and linseed. But if the scarifications 
become ulcerated and break into one another, 
we must be regulated by circumstances, and 
otherwise apply whatever else appears to be 
proper. 

15. When a varix is on the fore part of the 
leg, and is very superficial, or below the flesh, 
and the leg is black, and seems to stand in need 
of having the blood evacuated from it, such 
swellings are not, by any means, to be cut open; 
for, generally, large ulcers are the consequence 
of the incisions, owing to the influx from the 
varix. But the varix itself is to be punctured in 
many places, as circumstances may indicate. 

1 6. When you have opened a vein and ab- 
stracted blood, and although the fillet be loosed 
the bleeding does not stop, the member, wheth- 
er the arm or leg, is to be put into the reverse 
position to that from which the blood flows; so 
that the blood may flow backward, and it is to 
be allowed to remain in this position for a 
greater or less space of time. Then bind up the 
part while matters are so, no clots of blood be- 
ing allowed to remain in the opening. Then 
having applied a double compress, and wetted 
it with wine, apply above it clean wool which 
has been smeared with oil. For, although the 
flow of blood be violent, it will be stopped in 
this way. If a thrombus be formed in the open- 
ing, it will inflame and suppurate. Venesection 
is to be practiced when the person has dined 
more or less freely and drunk, and when some- 
what heated, and rather in hot weather than in 
cold. 

17. When in cupping, the blood continues 
to flow after the cupping-instrument has been 



150 Hippocrates 

removed, and if the flow of blood, or scrum be 
copious, the instrument is to be applied again 
before the part is healed up, so as to abstract 
what is left behind. Otherwise coagula of blood 
will be retained in the incisions and inflamma- 
tory ulcers will arise from them. In all such 
cases the parts are to be bathed with vinegar, 



after which they are not to be wetted; neither 
must the person lie upon the scarifications, but 
they are to be anointed with some of the medi- 
cines for bloody wounds. When the cupping- 
instrument is to be applied below the knee, or 
at the knee, it should be done, if possible, while 
the man stands erect. 



On Fistula 



FISTUL^E are produced by contusions and 
tubercles, and they are also occasioned by row- 
ing, or riding on horseback, when blood accu- 
mulates in the nates near the anus. For, having 
become putrid, it spreads to the soft parts (the 
breech being of a humid nature, and the flesh 
in which it spreads being soft), until the tuber- 
cle break and corrupt below at the anus. When 
this happens, a fistula is formed, having an ichor- 
ous discharge, and faeces pass by it, with fla- 
tus and much abomination. It is produced, then, 
by contusions when any of the parts about the 
anus are bruised by a blow,ora fall, or a wound, 
or by riding, or rowing, or any such cause. For 
blood is collected, and it, becoming corrupted, 
suppurates; and from the suppuration the same 
accidents happen, as have been described in the 
case of tubercles. 

2. In the first place, then, when you see any 
such tubercle formed, you must cut it open while 
still unripe, before it suppurate and burst into 
the rectum. But if a fistula be already formed 
when you undertake the case, take a stalk of 
fresh garlic, and having laid the man on his back, 
and separated his thighs on both sides, push 
down the stalk as far as it will go, and thereby 
measure the depth of the fistula. Then, having 
bruised the root of seseli to a very fine powder, 
and poured in some water, let it macerate for 
four days, and, mixing the water with honey, 
let the patient drink it, fasting, to the amount 
of three cyathi, and at the same time purge a- 
way the ascarides. Those who are left without 
treatment die. 

3. In the next place, having moistened the 
strip of cotton cloth, with the juice of the great 
tithymallus, and sprinkling on it the flos aeris, 
roasted and triturated, and having made it into 
a tent equal in length to the fistula, and having 
passed a thread through the ends of the tent and 
again through the stalk, and having placed the 
patient in a reclining position, and having ex- 
amined the ulcerated parts of the rectum with 
a speculum, pass the stalk by it, and when it 



reaches the rectum, take hold of it and draw it 
out until the tent be pushed through, and be 
brought on a level above and below. When it 
(the tent?) has been pushed inward, introduce 
a ball of horn into the rectum (the rectum hav- 
ing been previously smeared with Cimolian 
chalk), and leave it there, and when the patient 
wants to go to stool, let it be taken out and a- 
gain replaced, and let this practice be continued 
for five days. On the sixth day let it be removed, 
and drawing the tent out of the flesh, and after- 
wards pounding alum and filling the ball (pes- 
sary) and introducing it into the rectum, leave 
it until the alum melts. Anoint the rectum with 
myrrh until the parts appear to be united. 

4. Another method of cure: Taking a very 
slender thread of raw lint, and uniting it into 
five folds of the length of a span, and wrapping 
them round with a horse hair; then having made 
a director (specillum) of tin, with an eye at its 
extremity, and having passed through it the end 
of raw lint wrapped round as above described, 
introduce the director into the fistula, and, at 
the same time, introduce the index finger of 
the left hand per anum; and when the director 
touches the finger, bring it out with the finger, 
bending the extremity of the director and the 
end of the threads in it, and the director is to be 
withdrawn, but the ends of the threads are to 
be knotted twice or thrice, and the rest of the 
raw threads is to be twisted around and fastened 
into a knot. Then the patient is to be told that 
he may go and attend to his matters. The rest 
of the treatment: Whenever any part of the 
thread gets loose owing to the fistula becoming 
putrid, it is to be tightened and twisted every 
day; and should the raw thread rot before the 
fistula is eaten through, you must attach another 
piece of raw thread to the hair, pass it through, 
and tie it, for it was for this purpose that the 
hair was rolled round the raw lint, as it is not 
liable to rot. When the fistula has sloughed 
through, a soft sponge is to be cut into very 
slender pieces and applied, and then the flowers 



On Fistula: 



of copper, roasted, are to be frequently applied 
with a director; and the sponge smeared with 
honey is to be introduced with the index finger 
of the left hand, and pushed forward; and an- 
other bit of sponge being added, it is to be bound 
on in the same manner as in the operation for 
hemorrhoids. Next day, having loosed the band- 
ages, the fistula is to be washed with hot water, 
and cleansed, as far as possible, with the finger 
of the left hand by means of the sponge, and 
again the flos aeris is to be applied. This is to be 
done for seven days, for generally the coat of 
the fistula takes that time to slough through. 
The same mode of bandaging is to be persevered 
in afterwards, until the cure be completed. For 
in this way, the fistula being forcibly expanded 
by the sponge will not fill up and heal unequal- 
ly, but it will all become whole together. Dur- 
ing the treatment, the part should be bathed 
with plenty of warm water, and the patient kept 
on a spare diet. 

5 . When the fistula does not get eaten through, 
having first examined it with a sound, cut down 
as far as it passes, and sprinkle with the flos 
a*ris, and let it remain for five days. Then pour 
warm water upon it, and above lay flour mixed 
with water, and bind on it the leaves of beet. 
When the flos arris comes away, and the fistu- 
lous sore becomes clean, cure it as before de- 
scribed. But if the fistula be in a part which does 
not admit of this treatment, and if it be deep, 
syringe it with the flowers of copper, and myrrh, 
and natron, diluted with urine, and introduce 
a piece of lead into the orifice of the fistula so 
that it may not close. Syringe the fistula by 
means of a quill attached to a bladder, so that 
the injection may distend the fistula. But it does 
not heal unless it be cut open. 

6. If the anus gets inflamed, and there is pain, 
fever, a frequent desire of going to stool with- 
out passing anything, and the anus appears to 
protrude, owing to the inflammation, and if at 
times strangury come on, this disease is formed, 
when phlegm, collected from the whole body, 
is determined to the rectum. Warm things are 
beneficial in this case; for these, when applied, 
can attenuate and dissolve the phlegm, and di- 
lute the acrid and salt particles, so that the heat 
subsides, and the irritation in the rectum is re- 
moved. Wherefore it is to be treated thus: 
The patient is to be put into a hip-bath of hot 
water, and sixty grains of the grana gnidia are 
to be pounded and infused in a heminaof wine, 
with half a hemina of oil, and injected. This 
brings away phlegm and faeces. When the pa- 
tient does not take the hip-bath, boil eggs in 



dark-colored fragrant wine, and apply to the 
anus, and spread something warm below,cither 
a bladder filled with warm water, or linseed 
toasted and ground, and its meal stirred up and 
mixed equally with dark, fragrant wine, and oil, 
and this applied very warm as a cataplasm; or, 
having mixed barley and Egyptian alum pul- 
verized, form into an oblong ball (supposito- 
ry?) and warming it gently at the fire, make it 
into a cataplasm, foment, form it into shape 
with the fingers, and then making it quite tep- 
id, introduce it into the an us. The external parts 
are to be anointed with cerate, and a cataplasm 
of boiled garlic, with dark wine diluted, is to be 
applied. But if you remove these things, let him 
take the hip-bath of hot water, and having mix- 
ed together the juice of srychnos, the grease of 
a goose, swine's seam, chrysocolla, resin, and 
white wax, and then having melted in the same 
and mixed together, anoint with these things, 
and while the inflammation lasts, use the cata- 
plasm of boiled garlic. And if by these means 
he be freed from the pain, it is enough; but if 
not, give him the white meconium (Euphorbia 
peplus?), or, if not it, any other phlegmagoguc 
medicine. While the inflammation lasts, the diet 
should be light. 

7. The strangury comes on in this way: The 
bladder being heated from the rectum, phlegm 
is attracted by the heat, and by the phlegm (in- 
flammation?) the strangury is occasioned. If, 
then, as is frequently the case, it cease with the 
disease, well; but, if not, give any of the medi- 
cines for strangury. 

8. If procidentia ani take place, having fo- 
mented the part with a soft sponge, and anoint- 
ed it with a snail, bind the man's hands to- 
gether, and suspend him for a short time, and 
the gut will return. But if it still prolapse, and 
will not remain up, fasten a girdle round his 
loins and attach a shawl behind, and having 
pushed up the anus, apply to it a soft sponge, 
moistened with hot water in which the shav- 
ings of lotus have been boiled; pour of this de- 
coction upon the anus by squeezing the sponge, 
then, bringing the shawl below between the 
legs, fasten it at the navel. But if he wish to 
evacuate the bowels, let him do so upon a very 
narrow night-stool. Or, if the patient be a child, 
let him be placed on the feet of a woman, with 
his back reclined to her knees, and when the 
bowels are evacuated, let the legs be extended. 
In this way the anus will be the least disposed 
to fall out. When a watery and ichorous dis- 
charge flows from the rectum, wash it out with 
burnt lees of wine, and water from myrtle, and 



151 



Hippocrates 



having dried maiden-hair, pound and sift it, 
and apply as a cataplasm. But if there be a dis- 
charge of blood, having washed with the same, 
and pounded chalcitis, and the shavings of cy- 
press, or of juniper, or of stone-pine, or of tur- 
pentine, the latter in equal proportions with the 
chalcitis, apply as a cataplasm. Anoint the ex- 
ternal parts with thick cerate. 

9. When the gut protrudes and will not re- 
main in its place, scrape the finest and most com- 
pact silphium (assajcetida?) into small pieces 
and apply as a cataplasm, and apply a sternuta- 
tory medicine to the nose and provoke sneez- 
ing, and having moistened pomegranate rind 
with hot water, and having powdered alum in 
white wine, pour it on the gut, then apply rags, 
bind the thighs together for three days, and let 
the patient fast, only he may drink sweet wine. 
If even thus matters do not proceed properly, 
having mixed vermillion with honey, anoint. 

10. If procidentia am be attended with a dis- 
charge of blood, pare off the rind of the root of 
wakerobin, then pound and mix flour with it, 
and apply it warm as a cataplasm. Another: 
Having scraped off the rind of the most tender 
roots of the wild vine, which some call psiloth- 
rion,boi\ in a dark austere wine undiluted; then 
having pounded, apply as a tepid cataplasm; 
but mix also flour and stir it up with white wine 
and oil in a tepid state. Another: Having 
pounded the seed of hemlock, pour on it a fra- 
grant white wine, and then apply in a tepid 
state as a cataplasm. 

11. But if it be inflamed, having boiled in 
water the root of the ivy, finely powdered, and 



mixing the finest flour, and stirring it up with 
white wine, apply as a cataplasm, and mix up 
some fat with these things. Another: Take 
the root of the mandrake, especially the green 
(fresh) root, but otherwise the dried, and hav- 
ing cleaned the green root and cut it down, boil 
in diluted wine, and apply as a cataplasm; but 
the dry may be pounded and applied as a cata- 
plasm in like manner. Another: Having bruis- 
ed the inner part of a ripe cucumber to a soft 
state, apply as a cataplasm. 

12. If there be pain without inflammation, 
having roasted red natron, and pounded it to a 
fine powder, and added alum and roasted salts, 
finely triturated, mix together in equal propor- 
tions; then having mixed it up with the best 
pitch and spread upon a rag, apply, and bind. 
Another: Having pounded the green leaves 
of capers, put into a bag and bind on the part; 
and when it appears to burn, take it away and 
apply it afterward; or, if you have not the leaves 
of capers, pound the rind of its roots, and hav- 
ing mixed it up with dark-colored wine, bind 
on the part in the same manner. This is a good 
application also for pains of the spleen. Of these 
poultices, those which are cooling, stop the dis- 
charge; those which are emollient and heating, 
discuss; and those which are attractive, dry up 
and attenuate. This disease is formed when bile 
and phlegm become seated in the parts. When 
the anus is inflamed, it should be anointed with 
the ointment, the ingredients of which are res- 
in, oil, wax, plumbago, and suet, these being all 
melted and applied quite hot as a cataplasm. 



On Hemorrhoids 



THE disease of the hemorrhoids is formed in 
this way: if bile or phlegm be determined to the 
veins in the rectum, it heats the blood in the 
veins; and these veins becoming heated attract 
blood from the nearest veins, and being gorged 
the inside of the gut swells outwardly, and the 
heads of the veins are raised up, and being at 
the same time bruised by the faeces passing out, 
and injured by the blood collected in them, they 
squirt out blood, most frequently along with 
the faeces, but sometimes without faeces. It is to 
be cured thus: 

2. In the first place it should be known in 
what sort of a place they are formed. For cut- 
ting, excising, sewing, binding, apply ing putre- 
facicnt means to the anus, all these appear to 



be very formidable things, and yet, after all, 
they are not attended with mischief. I recom- 
mend seven or eight small pieces of iron to be 
prepared, a fathom in size, in thickness like a 
thick specillum, and bent at the extremity, and 
a broad piece should be on the extremity, like a 
small obolus. Having on the preceding day first 
purged the man with medicine, on the day of 
the operation apply the cautery. Having laid 
him on his back, and placed a pillow below the 
breech, force out the anus as much as possible 
with the fingers, and make the irons red-hot, 
and burn the pile until it be dried up, and so as 
that no part may be left behind. And burn so 
as to leave none of the hemorrhoids unburnt, 
for you should burn them all up. You will rcc- 



On Hemorrhoids 



'53 



ognizc the hemorrhoids without difficulty, for 
they project on the inside of the gut like dark- 
colored grapes, and when the anus is forced out 
they spurt blood. When the cautery is applied 
the patient's head and hands should be held so 
that he may not stir, but he himself should cry 
out, for this will make the rectum project the 
more. When you have performed the burning, 
boil lentils and tares, finely triturated in water, 
and apply as a cataplasm for five or six days. 
But on the seventh, cut a soft sponge into a 
very slender slice, its width should be about six 
inches square. Then a thin smooth piece of 
cloth, of the same size as the sponge, is to be 
smeared with honey and applied; and with the 
index finger of the left hand the middle of the 
sponge is to be pushed as far up as possible; and 
afterward wool is to be placed upon the sponge 
so that it may remain in the anus. And having 
girded the patient about the loins and fastened 
a shawl to the girdle, bring up this band from 
behind between the legs and attach it to the gir- 
dle at the navel. Then let the medicine which I 
formerly said is calculated to render the skin 
thick and strong, be bound on. These things 
should be kept on for not less than twenty days. 
The patient should once a day take a draught 
from flour or millet, or bran, and drink water. 
When the patient goes to stool the part should 
be washed with hot water. Every third day he 
should take the bath. 

3. Another method of cure: Having got the 
anus to protrude as much as possible, foment 
with hot water, and then cut off the extremities 
of the hemorrhoids. But this medicine should be 
prepared beforehand, as an application to the 
wound: Having put urine into a bronze ves- 
sel, sprinkle upon the urine the flower of bronze 
calcined and finely triturated; then, when it is 
moistened, shake the vessel and dry in the sun. 
When it becomes dry, let it be scraped down 
and levigated, and apply with the finger to the 
part, and having oiled compresses, apply them, 
and bind a sponge above. 

4. Another method: There grows upon the 
bleeding condy loma, a protuberance like the 
fruit of the mulberry, and if the condyloma be 
far without, an envelope of flesh is adherent to 
it. Having placed the man over two round 
stones upon his knees, examine, for you will 
find the parts near the anus between the but- 
tocks inflated, and blood proceeding from with- 
in. If, then, the condyloma below the cover be 
of a soft nature, bring it away with the finger, 
for there is no more difficulty in this than in 
skinning a sheep, to pass the finger between the 



hide and the flesh. And this should be accom- 
plished without the patient's knowledge, while 
he is kept in conversation. When the condy loma 
is taken off, streaks of blood necessarily flow 
from the whole of the torn part. It must be 
speedily washed with a decoction of galls, in a 
dry wine, and the bleeding vein will disappear 
along with the condyloma, and its cover will be 
replaced. The older it is, the more easy the cure. 

5. But if the condyloma be higher up, you 
must examine it with the speculum, and you 
should take care not to be deceived by the spec- 
ulum; for when expanded, it renders the condy- 
loma level with the surrounding parts, but 
when contracted, it shows the tumor right again . 
It is to be removed by smearing it with black 
hellebore on the finger. Then, on the third day, 
wash it out with a dry wine. You need not be 
surprised that there is no discharge of blood 
when you remove the condyloma, for neither, 
if you cut off the hands or legs at the articula- 
tions will there be any flow of blood; but if you 
cut them off above or below the joints, you will 
find there hollow veins which pour out blood, 
and you will have difficulty in stopping the 
bleeding. In the same manner, the bleeding 
vein in the anus, if you cut it above or below 
the point of separation of the condyloma, will 
pour forth blood; but if you take away the con- 
dylomaat its junction (with the natural parts?) 
there will be no flow of blood. If matters then 
be thus put to rights, it will be well; but other- 
wise burn it, taking care not to touch the place 
with the iron, but bringing it close so as to dry 
it up, and apply the flos asris in the urine. 

6. Another method of curing hemorrhoids: 
You must prepare a cautery like the arundo 
phragmites, and an iron that exactly fits is to be 
adapted to it; then the tube being introduced 
into the anus, the iron, red hot, is to be passed 
down it, and frequently drawn out, so that the 
part may bear the more heat, and no sore may 
result from the heating, and the dried veins may 
heal up. But if you are neither disposed to burn 
nor excise, having first fomented with plenty of 
hot water and turned out the anus, levigate 
myrrh, and having burnt galls and Egyptian 
alum, in the proportion of one and a half to the 
other things, and as much of melanteria; these 
things arc all to be used in a dry state. The 
hemorrhoid will separate under the use of these 
medicines, like a piece of burnt hide. You are 
to proceed thus until the whole are removed, 
and a half part of burnt chalcitis does the same 
thing. But if you wish to effect the cure by sup- 
positories, take the shell of the cuttle fish, a third 



Hippocrates 



part of plumbago, bitumen, alum, a little of the 
flos aeris, galls, a little verdigris; having poured 
a small quantity of boiled honey on these, and 
formed an oblong suppository, apply until you 
remove them. 

7. An hemorrhoid in a woman may be thus 
cured. Having fomented with plenty of hot wa- 



ter, boil in the water certain of the fragrant 
medicines, add pounded tamarisk, roasted lith- 
arge and galls, and pour on them white wine, 
and oil, and the grease of a goose, pounding all 
together. Give to use after fomenting. In fo- 
menting the anus is to be made to protrude as 
much as possible. 



On the Sacred Disease 



IT IS thus with regard to the disease called 
Sacred: it appears to me to be nowise more di- 
vine nor more sacred than other diseases, but 
has a natural cause from which it originates like 
other affections. Men regard its nature and 
cause as divine from ignorance and wonder, be- 
cause it is not at all like to other diseases. And 
this notion of its divinity is kept up by their in- 
ability to comprehend it, and the simplicity of 
the mode by which it is cured, for men are freed 
from it by purifications and incantations. But if 
it is reckoned divine because it is wonderful, in- 
stead of one there are many diseases which 
would be sacred; for, as I will show, there are 
others no less wonderful and prodigious, which 
nobody imagines to be sacred. The quotidian, 
tertian, and quartan fevers, seem to me no less 
sacred and divine in their origin than this dis- 
ease, although they are not reckoned so won- 
derful. And I see men become mad and dement- 
ed from no manifest cause, and at the same time 
doing many things out of place; and I have 
known many persons in sleep groaning and 
crying out, some in a state of suffocation, some 
jumping up and fleeing out of doors, and de- 
prived of their reason until they awaken, and 
afterward becoming well and rational as before, 
although they be pale and weak; and this will 
happen not once but frequently. And there are 
many and various things of the like kind, which 
it would be tedious to state particularly. 

They who first referred this malady to the 
gods appear tome to have been just such persons 
as the con jurors, purificators, mountebanks, and 
charlatans now are, who give themselves out for 
being excessively religious, and as knowing 
more than other people. Such persons, then, us- 
ing the divinity as a pretext and screen of their 
own inability to afford any assistance, have giv- 
en out that the disease is sacred, adding suitable 
reasons for this opinion, they have instituted a 
mode of treatment which is safe for themselves, 
namely, by applying purifications and incanta- 
tions, and enforcing abstinence from baths and 



many articles of food which are unwholesome 
to men in diseases. Of sea substances, the sur- 
mullet, the blacktail, the mullet, and the eel; 
for these are the fishes most to be guarded 
against. And of fleshes, those of the goat, the stag, 
the sow, and the dog: for these are the kinds 
of flesh which are aptest to disorder the bowels. 
Of fowls, the cock, the turtle, and the bustard, 
and such others as are reckoned to be particu- 
larly strong. And of potherbs, mint, garlic, and 
onions; for what is acrid does not agree with 
a weak person. And they forbid to have a black 
robe, because black is expressive of death; and 
to sleep on a goat's skin, or to wear it, and to 
put one foot upon another, or one hand upon 
another; for all these things are held to be hin- 
drances to the cure. All these they enjoin with 
reference to its divinity, as if possessed of more 
knowledge, and announcing beforehand other 
causes so that if the person should recover, 
theirs would be the honor and credit; and if he 
should die, they would have a certain defense, 
as if the gods, and not they, were to blame, see- 
ing they had administered nothing either to eat 
or drink as medicines, nor had overheated him 
with baths, so as to prove the cause of what had 
happened. But I am of opinion that (if this 
were true) none of the Libyans, who live in the 
interior, would be free from this disease, since 
they all sleep on goats' skins, and live upon 
goats' flesh; neither have they couch, robe, nor 
shoe that is not made of goat's skin, for they 
have no other herds but goats and oxen. But if 
these things, when administered in food, ag- 
gravate the disease, and if it be cured by absti- 
nence from them, godhead is not the cause at 
all; nor will purifications be of any avail, but it 
is the food which is beneficial and prejudicial, 
and the influence of the divinity vanishes. 

Thus, they who try to cure these maladies 
in this way, appear to me neither to reckon 
them sacred nor divine. For when they are re- 
moved by such purifications, and this method 
of cure, what is to prevent them from being 



On the Sacred Disease 



'55 



brought upon men and induced by other de- 
vices similar to these? So that the cause is no 
longer divine, but human. For whoever is able, 
by purifications and conjurations, to drive away 
such an affection, will be able, by other prac- 
tices, to excite it; and, according to this view, its 
divine nature is entirely done away with. By 
such sayings and doings, they profess to be pos- 
sessed of superior knowledge, and deceive man- 
kind by enjoining lustrations and purifications 
upon them, while their discourse turns upon 
the divinity and the godhead. And yet it would 
appear to me that their discourse savors not of 
piety, as they suppose, but rather of impiety, 
and as if there were no gods, and that what 
they hold to be holy and divine, were impious 
and unholy. This I will now explain. 

For, if they profess to know how to bring 
down the moon, darken the sun, induce storms 
and fine weather, and rains and droughts, and 
make the sea and land unproductive, and so 
forth, whether they arrogate this power as be- 
ing derived from mysteries or any other knowl- 
edge or consideration, they appear to me to prac- 
tice impiety, and either to fancy that there are 
no gods, or, if there are, that they have no abil- 
ity to ward off any of the greatest evils. How, 
then, are they not enemies to the gods? For if a 
man by magical arts and sacrifices will bring 
down the moon, and darken the sun, and in- 
duce storms, or fine weather, I should not be- 
lieve that there was anything divine, but hu- 
man, in these things, provided the power of the 
divine were overpowered by human knowledge 
and subjected to it. But perhaps it will be said, 
these things are not so, but, men being in want 
of the means of life, invent many and various 
things, and devise many contrivances for all 
other things, and for this disease, in every phase 
of the disease, assigning the cause to a god. Nor 
do they remember the same things once, but 
frequently. For, if they imitate a goat, or 
grind their teeth, or if their right side be 
convulsed, they say that the mother of the gods 
is the cause. But if they speak in a sharper 
and more intense tone, they resemble this state 
to a horse, and say that Poseidon is the cause. 
Or if any excrement be passed, which is often 
the case, owing to the violence of the disease, 
the appellation of Enodia is adhibited; or, if 
it be passed in smaller and denser masses, like 
bird's, it is said to be from Apollo Nomius. But 
if foam be emitted by the mouth, and the pa- 
tient kick with his feet, Ares then gets the 
blame. But terrors which happen during the 
night, and fevers, and delirium, and jump ings 



out of bed, and frightful apparitions, and flee- 
ing away, all these they hold to be the plots of 
Hecate, and the invasions of the Heroes, and use 
purifications and incantations, and, as appears 
to me, make the divinity to be most wicked and 
most impious. For they purify those laboring 
under this disease, with the same sorts of blood 
and the other means that are used in the case 
of those who are stained with crimes, and of 
malefactors, or who have been enchanted by 
men, or who have done any wicked act; who 
ought to do the very reverse, namely, sacrifice 
and pray, and, bringing gifts to the temples, 
supplicate the gods. But now they do none of 
these things, but purify; and some of the purifi- 
cations they conceal in the earth, and some they 
throw into the sea, and some they carry to the 
mountains where no one can touch or tread up- 
on them. But these they ought to take to the 
temples and present to the god, if a god be the 
cause of the disease. Neither truly do I count it 
a worthy opinion to hold that the body of man 
is polluted by god, the most impure by the most 
holy; for were it defiled, or did it suffer from 
any other thing, it would be like to be purified 
and sanctified rather than polluted by god. For 
it is the divinity which purifies and sanctifies 
the greatest of offenses and the most wicked, and 
which proves our protection from them. And 
we mark out the boundaries of the temples and 
the groves of the gods, so that no one may pass 
them unless he be pure, and when we enter 
them we are sprinkled with holy water, not as 
being polluted, but as laying aside any other pol- 
lution which we formerly had. And thus it ap- 
pears to me to hold, with regard to purifications. 
But this disease seems to me to be no more 
divine than others; but it has its nature such as 
other diseases have, and a cause whence it orig- 
inates, and its nature and cause are divine only 
just as much as all others are, and it is curable 
no less than the others, unless when, from length 
of time, it is confirmed, and has became strong- 
er than the remedies applied. Its origin is hered- 
itary, like that of other diseases. For if a phleg- 
matic person be born of a phlegmatic, and a 
bilious of a bilious, and a phthisical of a phthis- 
ical, and one having spleen disease, of another 
having disease of the spleen, what is to hinder 
it from happening that where the father and 
mother were subject to this disease, certain of 
their offspring should be so affected also? As 
the semen comes from all parts of the body, 
healthy particles will come from healthy parts, 
and unhealthy from unhealthy parts. And an- 
other great proof that it is in nothing more di- 



i 5 6 



Hippocrates 



vine than other diseases is, that it occurs in those 
who are of a phlegmatic constitution, but does 
not attack the bilious. Yet, if it were more di- 
vine than the others, this disease ought to befall 
all alike, and make no distinction between the 
bilious and phlegmatic. 

But the brain is the cause of this affection, as 
it is of other very great diseases, and in what 
manner and from what cause it is formed, I 
will now plainly declare. The brain of man, as 
in all other animals, is double, and a thin mem- 
brane divides it through the middle, and there- 
fore the pain is not always in the same part of 
the head; for sometimes it is situated on either 
side, and sometimes the whole is affected; and 
veins run toward it from all parts of the body, 
many of which are small, but two are thick, 
the one from the liver, and the other from the 
spleen. And it is thus with regard to the one 
from the liver: a portion of it runs downward 
through the partson the right side, near the kid- 
neys and the psoas muscles, to the inner part 
of the thigh, and extends to the foot. It is called 
vena cava. The other runs upward by the right 
veins and the lungs, and divides into branches 
for the heart and the right arm. The remaining 
part of it rises upward across the clavicle to the 
right side of the neck, and is superficial so as to 
be seen; near the ear it is concealed, and there it 
divides; its thickest, largest, and most hollow 
part ends in the brain; another small vein goes 
to the right ear, another to the right eye, and 
another to the nostril. Such are the distributions 
of the hepatic vein. And a vein from the spleen 
is distributed on the left side, upward and down- 
ward, like that from the liver, but more slender 
and feeble. 

By these veins we draw in much breath, since 
they are the spiracles of our bodies inhaling air 
to themselves and distributing it to the rest of 
the body, and to the smaller veins, and they cool 
and afterwards exhale it. For the breath cannot 
be stationary, but it passes upward and down- 
ward, for if stopped and intercepted, the part 
where it is stopped becomes powerless. In proof 
of this, when, in sitting or lying, the small veins 
arc compressed, so that the breath from the 
larger vein does not pass into them, the part is 
immediately seized with numbness; and it is so 
likewise with regard to the other veins. 

This malady, then, affects phlegmatic people, 
but not bilious. It begins to be formed while the 
foetus is still in utero. For the brain, like the oth- 
er organs, is depurated and grows before birth. 
If, then, in this purgation it be properly and 
moderately depurated, and neither more nor 



less than what is proper be secreted from it, the 
head is thus in the most healthy condition. If 
the secretion (melting) from the whole brain be 
greater than natural, the person, when he grows 
up, will have his head diseased, and full of 
noises, and will neither be able to endure the 
sun nor cold. Or, if the melting take place from 
any one part, either from the eye or ear, or if a 
vein has become slender, that part will be de- 
ranged in proportion to the melting. Or, should 
depuration not take place, but congestion ac- 
cumulate in the brain, it necessarily becomes 
phlegmatic. And such children as have an erup- 
tion of ulcers on the head, on the ears, and a- 
long the rest of the body, with copious dis- 
charges of saliva and mucus, these, in after 
life, enjoy best health; for in this way the 
phlegm which ought to have been purged off in 
the womb, is discharged and cleared away, and 
persons so purged, for the most part, are not 
subject to attacks of this disease. But such as 
have had their skin free from eruptions, and 
have had no discharge of saliva or mucus, nor 
have undergone the proper purgation in the 
womb, these persons run the risk of being seized 
with this disease. 

But should the dcfluxion make its way to the 
heart, the person is seized with palpitation and 
asthma, the chest becomes diseased, and some 
also have curvature of the spine. For when a 
defluxion of cold phlegm takes place on the 
lungs and heart, the blood is chilled, and the 
veins, being violently chilled, palpitate in the 
lungs and heart, and the heart palpitates, so that 
from this necessity asthma and orthopnoea su- 
pervene. For it does not receive the spirits as 
much breath as he needs until the defluxion of 
phlegm be mastered, and being heated is dis- 
tributed to the veins, then it ceases from its pal- 
pitation and difficulty of breathing, and this 
takes place as soon as it obtains an abundant 
supply; and this will be more slowly, provided 
the defluxion be more abundant, or if it be less, 
more quickly. And if the defluxions be more 
condensed, the epileptic attacks will be more 
frequent, but otherwise if it be rarer. Such are 
the symptoms when the defluxion is upon the 
lungs and heart; but if it be upon the bowels, 
the person is attacked with diarrhoea. 

And if, being shut out from all these outlets, 
its defluxion be determined to the veins I have 
formerly mentioned, the patient loses his speech, 
and chokes, and foam issues by the mouth, the 
teeth arc fixed, the hands are contracted, the eyes 
distorted, he becomes insensible, and in some 
cases the bowels are evacuated. And these symp- 



On the Sacred Disease 



'57 



toms occur sometimes on the left side, some- 
times on the right, and sometimes in both. The 
cause of everyone of these symptoms I will now 
explain. The man becomes speechless when the 
phlegm, suddenly descending into the veins, 
shuts out the air, and does not admit it either to 
the brain or to the vena cava, or to the ventricles, 
but interrupts the inspiration. For when a per- 
son draws in air by the mouth and nostrils, the 
breath goes first to the brain, then the greater 
part of it to the internal cavity, and part to the 
lungs, and part to the veins, and from them it 
is distributed to the other parts of the body a- 
long the veins; and whatever passes to the stom- 
ach cools, and does nothing more; and so also 
with regard to the lungs. But the air which 
enters the veins is of use (to the body) by en- 
tering the brain and its ventricles, and thus it 
imparts sensibility and motion to all the mem- 
bers, so that when the veins are excluded from 
the air by the phlegm and do not receive it, 
the man loses his speech and intellect, and the 
hands become powerless, and are contracted, 
the blood stopping and not being diffused, as 
it was wont; and the eyes are distorted owing 
to the veins being excluded from the air; and 
they palpitate; and froth from the lungs issues 
by the mouth. For when the breath does not 
find entrance to him, he foams and sputters 
like a dying person. And the bowels are evac- 
uated in consequence of the violent suffocation; 
and the suffocation is produced when the liver 
and stomach ascend to the diaphragm, and the 
mouth of the stomach is shut up; this takes 
place when the breath does not enter by the 
mouth, as it is wont. The patient kicks with his 
feet when the air is shut up in the lungs and 
cannot find an outlet, owing to the phlegm; and 
rushing by the blood upward and downward, 
it occasions convulsions and pain, and therefore 
he kicks with his feet. All these symptoms he 
endures when the cold phlegm passes into the 
warm blood, for it congeals and stops the blood. 
And if the deflexion be copious and thick, it 
immediately proves fatal to him, for by its cold 
it prevails over the blood and congeals it; or, if 
it be less, it in the first place obtains the mastery, 
and stops the respiration; and then in the course 
of time, when it is diffused along the veins and 
mixed with much warm blood, it is thus over- 
powered, the veins receive the air, and the pa- 
tient recovers his senses. 

Of little children who are seized with this dis- 
ease, the greater part die, provided thedefluxion 
be copious and humid, for the veins being slen- 
der cannot admit the phlegm, owing to its thick- 



ness and abundance; but the blood is cooled and 
congealed, and the child immediately dies. But 
if the phlegm be in small quantity, and make a 
defluxion into both the veins, or to those on ei- 
ther side, the children survive, but exhibit no- 
table marks of the disorder; for either the mouth 
is drawn aside, or an eye, the neck, or a hand, 
wherever a vein being filled with phlegm loses 
its tone, and is attenuated, and the part of the 
body connected with this vein is necessarily ren- 
dered weaker and defective. But for the most it 
affords relief for a longer interval; for the child 
is no longer seized with these attacks, if once it 
has contracted this impress of the disease, in 
consequence of which the other veins arc neces- 
sarily affected, and to a certain degree attenu- 
ated, so as just to admit the air, but no longer to 
permit the influx of phlegm. However, the parts 
are proportionally enfeebled whenever the veins 
are in an unhealthy state. When in striplings 
the defluxion is small and to the right side, they 
recover without leaving any marks of the dis- 
ease, but there is danger of its becoming habit- 
ual, and even increasing if not treated by suit- 
able remedies. Thus, or very nearly so, is the 
case when it attacks children. 

To persons of a more advanced age, it nei- 
ther proves fatal, nor produces distortions. For 
their veins are capacious and are filled with 
hot blood; and therefore the phlegm can nei- 
ther prevail nor cool the blood, so as to coagu- 
late it, but it is quickly overpowered and mixed 
with the blood, and thus the veins receive the 
air, and sensibility remains; and, owing to their 
strength, the aforesaid symptoms are less likely 
to seize them. But when this disease attacks 
very old people, it therefore proves fatal, or in- 
duces paraplegia, because the veins arc empty, 
and the blood scanty, thin, and watery. When, 
therefore, the defluxion is copious, and the sea- 
son winter, it proves fatal; for it chokes up the 
exhalents, and coagulates the blood if the de- 
fluxion be to both sides; but if to cither, it mere- 
ly induces paraplegia. For the blood being thin, 
cold, and scanty, can not prevail over the phlegm, 
but being itself overpowered, it is coagulated, 
so that those parts in which the blood is cor- 
rupted, lose their strength. 

The flux is to the right rather than to the left 
because the veins there are more capacious and 
numerous than on the left side, for on the one 
side they spring from the liver, and on the oth- 
er from the spleen. The defluxion and melting 
down take place most especially in the case of 
children in whom the head is heated cither by 
the sun or by fire, or if the brain suddenly con- 



Hippocrates 



ract a rigor, and then the phlegm is excreted. 
7 or it is melted down by the heat and diffusion 
>f the brain, but it is excreted by the congeal- 
ng and contracting of it, and thus a defluxion 
akes place. And in some this is the cause of the 
lisease, and in others, when the south wind 
juickly succeeds to northern breezes, it sudden- 
y unbinds and relaxes the brain, which is con- 
tacted and weak, so that there is an inundation 
f phlegm, and thus the defluxion takes place. 
The defluxion also takes place in consequence 
if fear, from any hidden cause, if we are f right- 
ned at any person's calling aloud, or while cry- 
tig, when one cannot quickly recover one's 
reath, such as of ten happens to children. When 
ny of these things occur, the body immediately 
hivers, the person becoming speechless cannot 
[raw his breath, but the breath (pneuma) stops, 
be brain is contracted, the blood stands still, 
nd thus the excretion and defluxion of the 
hlegm take place. In children, these are the 
auses of the attack at first. But to old persons 
winter is most inimical. For when the head and 
rain have been heated at a great fire, and then 
tie person is brought into cold and has a rigor, 
r when from cold he comes into warmth, and 
its at the fire, he is apt to suffer in the same way, 
nd thus he is seized in the manner described 
bove. And there is much danger of the same 
ling occurring, if in spring his head be exposed 
) the sun, but less so in summer, as the changes 
re not sudden. When a person has passed the 
kVentieth year of his life, this disease is not apt 
> seize him, unless it has become habitual 
rom childhood, or at least this is rarely or nev- 
r the case. For the veins are filled with blood, 
ad the brain consistent and firm, so that it 
oes not run down into the veins, or if it do, it 
oes not master the blood, which is copious and 
ot. 

But when it has gained strength from one's 
tiildhood, and become habitual, such a person 
sually suffers attacks, and is seized with them 
i changes of the winds, especially in south 
dnds, and it is difficult of removal. For the 
rain becomes more humid than natural, and 

inundated with phlegm, so that the deflux- 
>ns become more frequent, and the phlegm 
in no longer be excreted, nor the brain be dried 
p, but it becomes wet and humid. This you 
lay ascertain in particular, from beasts of the 
ock which arc seized with this disease, and 
lore especially goats, for they are most fre- 
uently attacked with it. If you will cut open 
ic head, you will find the brain humid, full of 
veat, and having a bad smell. And in this way 



truly you may see that it is not a god that in- 
jures the body, but disease. And so it is with 
man. For when the disease has prevailed for 
a length of time, it is no longer curable, as the 
brain is corroded by the phlegm, and melted, 
and what is melted down becomes water, and 
surrounds the brain externally, and overflows 
it; wherefore they are more frequently and read- 
ily seized with the disease. And therefore the 
disease is protracted, because the influx is thin, 
owing to its quantity, and is immediately over- 
powered by the blood and heated all through. 

But such persons as are habituated to the dis- 
ease know beforehand when they are about to 
be seized and flee from men; if their own house 
be at hand, they run home, but if not, to a de- 
serted place, where as few persons as possible 
will see them falling, and they immediately cov- 
er themselves up. This they do from shame of 
the affection, and not from fear of the divinity, 
as many suppose. And little children at first fall 
down wherever they may happen to be, from 
inexperience. But when they have been often 
seized, and feel its approach beforehand, they 
flee to their mothers, or to any other person they 
are acquainted with, from terror and dread of 
the affection, for being still infants they do not 
know yet what it is to be ashamed. 

Therefore, they are attacked during changes 
of the winds, and especially south winds, then 
also with north winds, and afterwards also with 
the others. These are the strongest winds, and 
the most opposed to one another, both as to di- 
rection and power. For, the north wind con- 
denses the air, and separates from it whatever 
is muddy and nebulous, and renders it clearer 
and brighter, and so in like manner also, all 
the winds which arise from the sea and other 
waters; for they extract the humidity and nebu- 
losity from all objects, and from men them- 
selves, and therefore it (the north wind) is the 
most wholesome of the winds. But the effects 
of the south are the very reverse. For in the first 
place it begins by melting and diffusing the con- 
densed air, and therefore it does not blow strong 
at first, but is gentle at the commencement, be- 
cause it is not able at once to overcome the dense 
and compacted air, which yet in a while it dis- 
solves. It produces the same effects upon the 
land, the sea, the rivers, the fountains, the yvells, 
and on every production which contains hu- 
midity, and this, there is in all things, some 
more, some less. For all these feel the effects of 
this wind, and from clear they become cloudy, 
from cold, hot; from dry, moist; and whatever 
earthen vessels are placed upon the ground, filled 



un tnc oacrca uiscasc 



vith wine or any other fluid, are affected with 
he south wind, and undergo a change. And the 
;un,thc moon, and the stars it renders blunter in 
ippearancc than they naturally are. When, then, 
t possesses such powers over things so great 
ind strong, and the body is made to feel and 
mdergo changes in the changes of the winds, it 
iccessarily follows that the brain should bedis- 
olved and overpowered with moisture, and that 
he veins should become more relaxed by the 
.outh winds, and that by the north the healthiest 
x>rtion of the brain should become contracted, 
vhile the most morbid and humid is secreted, 
ind overflows externally, and that catarrhs 
hould thus take place in the changes of these 
vinds. Thus is this disease formed and prevails 
rom those things which enter into and go out 
>f the body, and it is not more difficult to under- 
tand or to cure than the others, neither is it 
nore divine than other diseases. 

Men ought to know that from nothing else 
>ut the brain come joys, delights, laughter and 
ports, and sorrows, griefs, despondency, and 
amentations. And by this, in an especial man- 
ler, we acquire wisdom and knowledge, and 
ee and hear, and know what are foul and what 
ire fair, what are bad and what are good, what 
ire sweet, and what unsavory; some we dis- 
riminate by habit, and some we perceive by 
heir utility. By this we distinguish objects of 
elish and disrelish, according to the seasons; 
ind the same things do not always please us. 
Vnd by the same organ we become mad and 
lelirious, and fears and terrors assail us, some 
>y night, and some by day, and dreams and un- 
imely wanderings, and cares that are not suit- 
,ble, and ignorance of present circumstances, 
lesuetude, and unskilfulness. All these things 
ve. endure from the brain, when it is not healthy, 
>ut is more hot, more cold, more moist, or more 
Iry than natural, or when it suffers any other 
>reternaturaiand unusual affection. And webe- 
ome mad from its humidity. For when it is 
nore moist than natural, it is necessarily put 
nto motion, and the affection being moved, 
icither the sight nor hearing can be at rest, and 
he tongue speaks in accordance with the sight 
nd hearing. 

As long as the brain is at rest, the man en- 
oys his reason, but the depravement of the 
>rain arises from phlegm and bile, either of 
vhich you may recognize in this manner: 
"hose who are mad from phlegm are quiet, and 
lo not cry out nor make a noise; but those from 
>ile are vociferous, malignant, and will not 
>e quiet, but are always doing something im- 



159 

proper. If the madness be constant, these are 
the causes thereof. But if terrors and fears as- 
sail, they are connected with derangement of the 
brain, and derangement is owing to its being 
heated. And it is heated by bile when it is deter- 
mined to the brain along the bloodvessels run- 
ning from the trunk; and fear is present until it 
returns again to the veins and trunk, when it 
ceases. He is grieved and troubled when the 
brain is unseasonably cooled and contracted be- 
yond its wont. This it suffers from phlegm, and 
from the same affection the patient becomes ob- 
livious. He calls out and screams at night when 
the brain is suddenly heated. The bilious endure 
this. But the phlegmatic are not heated, except 
when much blood goes to the brain, and creates 
an ebullition. Much blood passes along the 
aforesaid veins. But when the man happens to 
see a frightful dream and is in fear as if awake, 
then his face is in a greater glow, and the eyes 
are red when the patient is in fear. And the un- 
derstanding meditates doing some mischief, and 
thus it is affected in sleep. But if, when awak- 
ened, he returns to himself, and the blood is a- 
gain distributed along the veins, it ceases. 

In these ways I am of the opinion that the 
brain exercises the greatest power in the man. 
This is the interpreter to us of those things which 
emanate from the air, when the brain hap- 
pens to be in a sound state. But the air supplies 
sense to it. And the eyes, the ears, the tongue 
and the feet, administer such things as the brain 
cogitates. For inasmuch as it is supplied with 
air, does it impart sense to the body. It is the 
brain which is the messenger to the understand- 
ing. For when the man draws the breath into 
himself, it passes first to the brain, and thus the 
air is distributed to the rest of the body, leav- 
ing in the brain its acme, and whatever has 
sense and understanding. For if it passed first to 
the body and last to the brain, then having left 
in the flesh and veins the judgment, when it 
reached the brain it would be hot, and not at 
all pure, but mixed with the humidity from 
flesh and blood, so as to be no longer pure. 

Wherefore, I say, that it is the brain which 
interprets the understanding. But the dia- 
phragm has obtained its name (<pvcs) from ac- 
cident and usage, and not from reality or na- 
ture, for I know no power which it possesses, 
either as to sense or understanding, except that 
when the man is affected with unexpected joy 
or sorrow, it throbs and produces palpitations, 
owing to its thinness, and as having no belly to 
receive anything good or bad that may present 
themselves to it, but it is thrown into commo- 



i6o 



Hippocrates 



tion by both these, from its natural weakness. 
It then perceives beforehand none of those things 
which occur in the body, but has received its 
name vaguely and without any proper reason, 
like the parts about the heart, which are called 
auricles, but which contribute nothing towards 
hearing. Some say that we think with the heart, 
and that this is the part which is grieved, and 
experiences care. But it is not so; only it con- 
tracts like the diaphragm, and still more so for 
the same causes. For veins from all parts of the 
body run to it, and it has valves, so as to per- 
ceive if any pain or pleasurable emotion befall 
the man.Forwhen grieved the body necessarily 
shudders, and is contracted, and from excessive 
joy it is affected in like manner. Wherefore the 
heart and the diaphragm are particularly sensi- 
tive, they have nothing to do, however, with 
the operations of the understanding, but of all 
these the brain is the cause. Since, then, the brain, 
as being the primary seat of sense and of the 
spirits, perceives whatever occurs in the body, 
if any change more powerful than usual take 
place in the air, owing to the seasons, the brain 
becomes changed by the state of the air. For, on 
this account, the brain first perceives, because, 
I say, all the most acute, most powerful, and 
most deadly diseases, and those which are most 
difficult to be understood by the inexperienced, 
fall upon the brain. 
And the disease called the Sacred arises from 



causes as the others, namely, those things which 
enter and quit the body, such as cold, the sun, 
and the winds, which are ever changing and 
are never at rest. And these things are divine, 
so that there is no necessity for making a dis- 
tinction, and holding this disease to be more 
divine than the others, but all are divine, and 
all human. And each has its own peculiar na- 
ture and power, and none is of an ambiguous 
nature, or irremediable. And the most of them 
are curable by the same means as those by which 
they were produced. For any other thing is food 
to one, and injurious to another. Thus, then, 
the physician should understand and distin- 
guish the season of each, so that at one time he 
may attend to the nourishment and increase, 
and at another to abstraction and diminution. 
And in this disease as in all others, he must 
strive not to feed the disease, but endeavor to 
wear it out by administering whatever is most 
opposed to each disease, and not that which fa- 
vors and is allied to it. For by that which is allied 
to it, it gains vigor and increase, but it wears 
out and disappears under the use of that which 
is opposed to it. But whoever is acquainted with 
such a change in men, and can render a man 
humid and dry, hot and cold by regimen, could 
also cure this disease, if he recognizes the prop- 
er season for administering his remedies, with- 
out minding purifications, spells, and all other 
illiberal practices of a like kind. 



GALEN 
ON THE NATURAL FACULTIES 



BIOGRAPHICAL NOTE 
GALEN, c. A.D. i$o-c. 2.00 



GALEN the physician was born at Pergamum, 
the capital of Mysia in Asia Minor, which had 
once been a center of art and learning and 
which still possessed at the time of Galen's 
birth the second greatest library in the ancient 
world and a temple of ^Esculapius. His father 
was an architect or engineer, "amiable, just, 
worthy, and benevolent"; his mother "had a 
very bad temper, at times used to bite her 
serving-maids, and was forever shouting at 
my father and quarrelling with him worse 
than Xanthippe with Socrates." "When I 
compared the excellence of my father's dis- 
position with the disgraceful passions of my 
mother," Galen wrote, "I resolved to love and 
imitate the former qualities and to hate and 
avoid the latter." 

The father provided a liberal education for 
his son, and by the age of seventeen or eighteen 
Galen was familiar with the Platonic, Aristo- 
telian, Stoic, and Epicurean philosophies. 
About this time, in obedience to a dream of 
his father, he began the study of medicine in 
his native city. When he fell ill from over- 
work, he kept a careful record of his symp- 
toms. After his father's death, he left 
Pergamum for Smyrna in order to study with 
Pelops the physician and Albinus the peripa- 
tetic. In search of more knowledge he roamed 
through Greece, Cilicia, Phoenicia, Palestine, 
Crete, Cyprus, and finally visited the famous 
medical school at Alexandria, which was still the 
best place to learn anatomy, although the dissec- 
tion of the human body was no longer allowed. 

On his return to Pergamum in 157-158, 
Galen was appointed physician and surgeon 
to the gladiators; he supervised their diet and 
treated their wounds. He also had a private 
practice, continued the study of philosophy, 
and wrote the first of his many treatises. 

In the first years of the reign of Marcus 
Aurelius, Galen went to Rome, where he soon 
acquired fame as a physician and as a philoso- 
pher. He healed the celebrated Aristotelian, 
Eudemus, and other persons of distinction, 
and by his learning attracted to his lectures 
many of the most eminent people of Rome, 



including the consul Flavius Boethus. His 
success earned for him the titles of "Para- 
doxologus," the wonder-speaker, and "Para- 
doxopoeus," the wonder-worker. 

Despite his name, meaning "gentle" or 
"peaceful," and his disapproval of his mother's 
temper, Galen was an incessant critic of the 
contemporary medical sects then flourishing 
in Rome. He opposed all fads and cults, the 
tyranny of theory and the contempt of theory, 
and every doctor who lost sight of what he 
held to be the Hippocratic teaching on the 
unity of the living organism and the force of 
"what nature does." The enmities he incurred 
by polemical activity may have caused his 
sudden departure from Rome in 168 and re- 
tirement to Pergamum. He was soon recalled 
by imperial command. Marcus Aurelius, who 
was one of his patients, desired his attendance 
for the campaigns against the Germans. But 
Galen did not wish to go and in the end was 
allowed to remain at Rome as physician to 
Commodus, the young heir to the throne. 

Little is known of Galen after this appoint- 
ment. He certainly devoted much of his time 
to writing. He left five hundred treatises writ- 
ten in clear Attic Greek. One of them argued 
"That the best Physician is also a Philoso- 
pher," and many of his own works dealt with 
philosophical problems. In his De Libris pro- 
priis he mentions one hundred and twenty-four 
philosophical treatises, which include commen- 
taries on the Categories and Analytics of Aris- 
totle, and on the Timccus and Philebus of Plato. 
He also wrote five treatises on Ancient Comedy. 
Only fragments remain of his non-medical writ- 
ings. Of the surviving medical works some 
eighty or ninety are believed to have been writ- 
ten by him; sixty-five are of doubtful author- 
ship or certainly spurious. Fifteen of his com- 
mentaries on the Hippocratic works are extant. 

Galen was apparently in Rome during the 
fire of 191, when his library burned, and he 
was still lecturing and practising during the 
reign of Pertinax. He may have spent his last 
years as physician-in-ordinary to the emperor. 
He died at the turn of the century. 



163 



Contents 



BIOGRAPHICAL NOTE, 163 
BOOK ONE, 167; BOOK Two, 183; BOOK THREE, 199 



GALEN 

ON THE NATURAL FACULTIES 



Book One 



1. Since feeling and voluntary motion are 
peculiar to animals, whilst growth and nutri- 
tion are common to plants as well, we may look 
on the former as effects of the soul and the lat- 
ter as effects of the nature. And if there be any- 
one who allows a share in soul to plants as well, 
and separates the two kinds of soul, naming 
the kind in question vegetative, and the other 
sensory, this person is not saying anything else, 
although his language is somewhat unusual. 
We, however, for our part, are convinced that 
the chief merit of language is clearness, and we 
know that nothing detracts so much from this 
as do unfamiliar terms; accordingly we employ 
those terms which the bulk of people are accus- 
tomed to use, and we say that animals are gov- 
erned at once by their soul and by their nature, 
and plants by their nature alone, and that growth 
and nutrition are the effects of nature, not of 
soul. 

2. Thus we shall enquire, in the course of 
this treatise, from what faculties these effects 
themselves, as well as any other effects of na- 
ture which there may be, take their origin. 

First, however, we must distinguish and ex- 
plain clearly the various terms which we are 
going to use in this treatise, and to what things 
we apply them; and this will prove to be not 
merely an explanation of terms but at the same 
time a demonstration of the effects of nature. 

When, therefore, such and such a body un- 
dergoes no change from its existing state, we 
say that it is at rest; but, if it departs from this 
in any respect we then say that in this respect it 
undergoes motion. Accordingly, when it de- 
parts in various ways from its pre-existing state, 
it will be said to undergo various kinds of 
motion. Thus, if that which is white becomes 
black, or what is black becomes white, it under- 
goes motion in respect to colour; or if what was 
previously sweet now becomes bitter, or, con- 
versely, from being bitter now becomes sweet, 
it will be said to undergo motion in respect to 
flavour; to both of these instances, as well as to 



those previously mentioned, we shall apply the 
term qualitative motion. And further, it is not 
only things which are altered in regard tocolour 
and flavour which, we say, undergo motion; 
when a warm thing becomes cold, and a cold 
warm, here too we speak of its undergoing mo- 
tion; similarly also when anything moist be- 
comes dry, or dry moist. Now, the common term 
which we apply to all these cases is alteration. 

This is one kind of motion. But there is 
another kind which occurs in bodies which 
change their position, or as we say, pass from 
one place to another; the name of this is trans- 
ference. 

These two kinds of motion, then, are simple 
and primary, while compounded from them 
we have growth and decay, as when a small 
thing becomes bigger, or a big thing smaller, 
each retaining at the same time its particular 
form. And two other kinds of motion arc gene- 
sis and destruction, genesis being a coming into 
existence, and destruction being the opposite. 

Now, common to all kinds of motion is 
change from the pre-existing state, while com- 
mon to all conditions of rest is retention of the 
pre-existing state. The Sophists, however, while 
allowing that bread in turning into blood be- 
comes changed as regards sight, taste, and 
touch, will not agree that this change occurs in 
reality. Thus some of them hold that all such 
phenomena are tricks and illusions of our 
senses; the senses, they say, are affected now 
in one way, now in another, whereas the under- 
lying susbtance does not admit of any of these 
changes to which the names are given. Others 
(such as Anaxagoras) will have it that the quali- 
ties do exist in it, but that they are unchangeable 
and immutable from eternity to eternity, and 
that these apparent alterations are brought 
about by separation and combination. 

Now, if I were to go out of my way to con- 
fute these people, my subsidiary task would be 
greater than my main one. Thus, if they do not 
know all that has been written, "On Complete 



1 68 



Galen 



Alteration of Substance" by Aristotle, and after 
him by Chrysippus, I must beg of them to 
make themselves ramiliar with these men's writ- 
ings. If, however, they know these, and yet will- 
ingly prefer the worse views to the better, they 
will doubtless consider my arguments foolish 
also. I have shown elsewhere that these opinions 
were shared by Hippocrates, who lived much 
earlier than Aristotle. In fact, of all those known 
to us who have been both physicians and philos- 
ophers Hippocrates was the first who took in 
hand to demonstrate that there are, in all, four 
mutually interacting qualities, and that to the 
operation of these is due the genesis and destruc- 
tion of all things that come into and pass out of 
being. Nay, more; Hippocrates was also the first 
to recognise that all these qualities undergo an 
intimate mingling with one another; and at 
least the beginnings of the proofs to which Aris- 
totle later set his hand are to be found first in 
the writings of Hipprocates. 

As to whether we are to suppose that the sub- 
stances as well as their qualities undergo this 
intimate mingling, as Zeno of Citmm after- 
wards declared, I do not think it necessary to 
go further into this question in the present 
treatise; for immediate purposes we only need 
to recognize the complete alteration of sub- 
stance. In this way, nobody will suppose that 
bread represents a kind of meeting-place for 
bone, flesh, nerve, and all the other parts, and 
that each of these subsequently becomes sepa- 
rated in the body and goes to join its own kind; 
before any separation takes place, the whole of 
the bread obviously becomes blood; (at any 
rate, if a man takes no other food for a pro- 
longed period, he will have blood enclosed in 
his veins all the same). And clearly this dis- 
proves the view of those who consider the ele- 
ments unchangeable, as also, for that matter, 
does the oil which is entirely used up in the 
flame of the lamp, or the faggots which, in a 
somewhat longer time, turn into fire. 

I said, however, that I was not going to enter 
into an argument with these people, and it was 
only because the example was drawn from the 
subject-matter of medicine, and because I need 
it for the present treatise, that I have mentioned 
it. We shall then, as I said, renounce our con- 
troversy with them, since those who wish may 
get a good grasp of the views of the ancients 
from our own personal investigations into these 
matters. 

The discussion which follows we shall de- 
vote entirely, as we originally proposed, to an 
enquiry into the number and character of the 



faculties of Nature, and what is the effect which 
each naturally produces. Now, of course,! mean 
by an effect that which has already come into 
existence and has been completed by the activity 
of these faculties for example, blood, flesh, or 
nerve. And activity is the name I give to the ac- 
tive change or motion, and the cause of this I 
call a faculty. Thus, when food turns into blood, 
the motion of the food is passive, and that of 
the vein active. Similarly, when the limbs have 
their position altered, it is the muscle which pro- 
duces, and the bones which undergo the mo- 
tion. In these cases I call the motion of the vein 
and of the muscle an activity, and that of the 
food and the bones a symptom or affection, since 
the first group undergoes alteration and the 
second group is merely transported. One might, 
therefore, also speak of the activity as an effect 
of Nature for example, digestion, absorption, 
blood-production; one could not, however, in 
every case call the effect an activity; thus flesh 
is an effect of Nature, but it is, of course, not an 
activity. It is, therefore, clear that one of these 
terms is used in two senses, but not the other. 

3. It appears to me, then, that the vein, as 
well as each of the other parts, functions in 
such and such a way according to the manner in 
which the four qualities are mixed. There are, 
however, a considerable number of not undis- 
tinguished men philosophers and physicians 
who refer action to the Warm and the Cold, 
and who subordinate to these, as passive, the 
Dry and the Moist; Aristotle, in fact, was the 
first who attempted to bring back the causes of 
the various special activities to these principles, 
and he was followed later by the Stoic school. 
These latter, of course, could logically make ac- 
tive principles of the Warm and Cold, since they 
refer the change of the elements themselves in- 
to one another to certain diffusions and conden- 
sations. This does not hold of Aristotle, how- 
ever; seeing that he employed the four qualities 
to explain the genesis of the elements, he ought 
properly to have also referred the causes of all 
the special activities to these. How is it that he 
uses the four qualities in his book "On Genesis 
and Destruction/' whilst in his "Meteorology," 
his "Problems," and many other works he uses 
the two only ? Of course, if anyone were to main- 
tain that in the case of animals and plants the 
Warm and Cold are more active, the Dry and 
Moist less so, he might perhaps have even Hip- 
pocrates on his side; but if he were to say that 
this happens in all cases, he would, I imagine, 
lack support, not merely from Hippocrates, but 
even from Aristotle himself if, at least, Aris- 



On the Natural Faculties 1, 1-6 



169 



totlc chose to remember what he himself taught 
us in his work "On Genesis and Destruction,'* 
not as a matter of simple statement, but with an 
accompanying demonstration. I have, however, 
also investigated these questions, in so far as 
they are of value to a physician, in my work 
"On Temperaments." 

4. The so-called blood-making faculty in the 
veins, then, as well as all the other faculties, 
fall within the category of relative concepts; 
primarily because the faculty is the cause of 
the activity, but also, accidentally, because it is 
the cause of the effect. But, if the cause is rela- 
tive to something for it is the cause of what 
results from it, and of nothingelse it is obvious 
that the faculty also falls into the category of the 
relative; and so long as we are ignorant of the 
true essence of the cause which is operating, we 
call it a faculty. Thus we say that there exists 
in the veins a blood-making faculty, as also a 
digestive faculty in the stomach, a pulsatile fac- 
ulty in the heart, and in each of the other parts 
a special faculty corresponding to the function 
or activity of that part. If, therefore, we are to 
investigate methodically the number and kinds 
of faculties, we must begin with the effects; for 
each of these effects comes from a certain activ- 
ity, and each of these again is preceded by a 
cause. 

5. The effects of Nature, then, while the ani- 
mal is still being formed in the womb, are all 
the different parts of its body; and after it has 
been born, an effect in which all parts share is 
the progress of each to its full size, and there- 
after its maintenance of itself as long as pos- 
sible. 

The activities corresponding to the three ef- 
fects mentioned are necessarily three one to 
each namely, Genesis, Growth, and Nutrition. 
Genesis, however, is not a simple activity of 
Nature, but is compounded of alteration and 
of shaping. That is to say, in order that bone, 
nerve, veins, and all other [tissues] may come 
into existence, the underlying substance from 
which the animal springs must be altered; and 
in order that the substance so altered may ac- 
quire its appropriate shape and position, its 
cavities, outgrowths, attachments, and so forth, 
it has to undergo a shaping or formative proc- 
ess. One would be justified in calling this sub- 
stance which undergoes alteration the material 
of the animal, just as wood is the material of a 
ship, and wax of an image. 

Growth is an increase and expansion in 
length, breadth, and thickness of the solid 
parts of the animal (those which have been 



subjected to the moulding or shaping process). 
Nutrition is an addition to these, without ex- 
pansion. 

6. Let us speak then, in the first place, of 
Genesis, which, as we have said, results from 
alteration together with shaping. 

The seed having been cast into the womb or 
into the earth (for there is no difference), then, 
after a certain definite period, a great number 
of parts become constituted in the substance 
which is being generated; these differ as re- 
gards moisture, dryness, coldness and warmth, 
and in all the other qualities which naturally 
derive therefrom. These derivative qualities, 
you are acquainted with, if you have given any 
sort of scientific consideration to the question of 
genesis and destruction. For, first and foremost 
after the qualities mentioned come the other so- 
called tangibledistinctions, and after them those 
which appeal to taste, smell, and sight. Now, 
tangible distinctions are hardness and softness, 
viscosity, friability, lightness, heaviness, density, 
rarity, smoothness, roughness, thickness and 
thinness; all of these have been duly mentioned 
by Aristotle. And of course you know those 
which appeal to taste, smell, and sight. There- 
fore, if you wish to know which alterative fac- 
ulties are primary and elementary, they are 
moisture, dryness, coldness, and warmth, and 
if you wish to know which ones arise from the 
combination of these, they will be found to be 
in each animal of a number corresponding to 
its sensible elements. The name sensible ele- 
ments is given to all the homogeneous parts of 
the body, and these are to be detected not by 
any system, but by personal observation of dis- 
sections. 

Now Nature constructs bone,cartilage, nerve, 
membrane, ligament, vein, and so forth, at the 
first stage of the animal's genesis, employing at 
this task a faculty which is, in general terms, 
generative and alterative, and, in more detail, 
warming, chilling, drying, or moistening; or 
such as spring from the blending of these, for 
example, the bone-producing, nerve-producing, 
and cartilage-producing faculties (since for the 
sake of clearness these names must be used as 
well). 

Now the peculiar flesh of the liver is of this 
kind as well, also that of the spleen, that of the 
kidneys, that of the lungs, and that of the heart; 
so also the proper substance of the brain, stom- 
ach, gullet, intestines, and uterus is a sensible ele- 
ment, of similar parts all through, simple, and 
uncompounded. That is to say, if you remove 
from each of the organs mentioned its arteries, 



Galen 



veins, and nerves, the substance remaining in 
each organ is, from the point of view of the 
senses, simple and elementary. As regards those 
organs consisting of two dissimilar coats, of 
which each is simple, of these organs the coats 
are the elements for example, the coats of the 
stomach, oesophagus, intestines, and arteries; 
each of these two coats has an alterative facul- 
ty peculiar to it, which has engendered it from 
the menstrual blood of the mother. Thus the 
special alterative faculties in each animal arc 
of the same number as the elementary parts; and 
further, the activities must necessarily corre- 
spond each to one of the special parts, just as 
each part has its special use for example, those 
ducts which extend from the kidneys into the 
bladder, and which are called ureters; for these 
are not arteries, since they do not pulsate nor do 
they consist of two coats; and they arc not veins, 
since they neither contain blood, nor do their 
coats in any way resemble those of veins; from 
nerves they differ still more than from the struc- 
tures mentioned. 

"What, then, are they?" someone asks as 
though every part must necessarily be either an 
artery, a vein, a nerve, or a complex of these, 
and as though the truth were not what I am 
now stating, namely, that every one of the vari- 
ous organs has its own particular substance. For 
in fact the two bladders that which receives 
the urine, and that which receives the yellow 
bile not only differ from all other organs, but 
also from one another. Further, the ducts which 
spring out like kinds of conduits from the gall- 
bladder and which pass into the liver have no 
resemblance either to arteries, veins or nerves. 
But these parts have been treated at a greater 
length in my work "On the Anatomy of Hip- 
pocrates," as well as elsewhere. 

As for the actual substance of the coats of 
the stomach, intestine, and uterus, each of these 
has been rendered what it is by a special alter- 
ative faculty of Nature; while the bringing of 
these together, the combination therewith of 
the structures which are inserted into them, 
the outgrowth into the intestine,* the shape of 
the inner cavities, and the like, have all been 
determined by a faculty which we call the shap- 
ing or formative faculty; this faculty we also 
state to be artistic nay, the best and highest 
art doing everything for some purpose, so 
that there is nothing ineffective or superfluous, 
or capable of being better disposed. This, how- 

* By this is meant the duodenum, considered as 
an outgrowth or prolongation of the stomach to- 
wards the intestines. 



ever, I shall demonstrate in my work "On the 
Use of Parts." 

7. Passing now to the faculty of Growth let 
us first mention that this, too, is present in the 
foetus in utero as is also the nutritive faculty, 
but that at that stage these two faculties arc, as 
it were, handmaids to those already mentioned, 
and do not possess in themselves supreme au- 
thority. When, however, the animal has at- 
tained its complete size, then, during the whole 
period following its birth and until the acme 
is reached, the faculty of growth is predomi- 
nant, while the alterative and nutritive facul- 
ties are accessory in fact, act as its handmaids. 
What, then, is the property of this faculty of 
growth? To extend in every direction that 
which has already come into existence that is 
to say, the solid parts of the body, the arteries, 
veins, nerves, bones, cartilages, membranes, lig- 
aments, and the various coats which we have 
just called elementary, homogeneous, and sim- 
ple. And I shall state in what way they gain 
this extension in every direction, first giving an 
illustration for the sake of clearness. 

Children take the bladders of pigs, fill them 
with air, and then rub them on ashes near the 
fire, so as to warm, but not to injure them. This 
is a common game in the district of Ionia, and 
among not a few other nations. As they rub, 
they sing songs, to a certain measure, time, and 
rhythm, and all their words are an exhortation 
to the bladder to increase in size. When it ap- 
pears to them fairly well distended, they again 
blow air into it and expand it further; then they 
rub it again. This they do several times, until 
the bladder seems to them to have become large 
enough. Now, clearly, in these doings of the 
children, the more the interior cavity of the 
bladder increases in size, the thinner, necessari- 
ly, does its substance become. But, if the chil- 
dren were able to bring nourishment to this 
thin part, then they would make the bladder big 
in the same way that Nature does. As it is, how- 
ever, they cannot do what Nature does, for to 
imitate this is beyond the power not only of chil- 
dren, but of any one soever; it is a property of 
Nature alone. 

It will now, therefore, be clear to you that 
nutrition is a necessity for growing things. For 
if such bodies were distended, but not at the 
same time nourished, they would take on a 
false appearance of growth, not a true growth. 
And further, to be distended in all directions 
belongs only to bodies whose growth is directed 
by Nature; for those which are distended by us 
undergo this distension in one direction but 



On the Natural Faculties I, 6-10 



grow less in the others; it is impossible to find 
a body which will remain entire and not be 
torn through whilst we stretch it in the three 
dimensions. Thus Nature alone has the power 
to expand a body in all directions so that it re- 
mains unruptured and preserves completely its 
previous form. 

Such then is growth, and it cannot occur 
without the nutriment which flows to the part 
and is worked up into it. 

8. We have, then, it seems, arrived at the 
subject of Nutrition, which is the third and re- 
maining consideration which we proposed at 
the outset. For, when the matter which flows to 
each part of the body in the form of nutriment 
is being worked up into it, this activity is nu- 
trition, and its cause is the nutritive faculty. Of 
course, the kind of activity here involved is also 
an alteration, but not an alteration like that oc- 
curring at the stage of genesis. For in the latter 
case something comes into existence which did 
not exist previously, while in nutrition the in- 
flowing material becomes assimilated to that 
which has already come into existence. There- 
fore, the former kind of alteration has with rea- 
son been termed genesis, and the latter, assimi- 
lation. 

9. Now, since the three faculties of Nature 
have been exhaustively dealt with, and the ani- 
mal would appear not to need any others (be- 
ing possessed of the means for growing, for at- 
taining completion, and for maintaining itself 
as long a time as possible), this treatise might 
seem to be already complete, and to constitute an 
exposition of all the faculties of Nature. If, how- 
ever, one considers that it has not yet touched 
upon any of the parts of the animal (I mean the 
stomach, intestines, liver, and the like), and 
that it has not dealt with the faculties resident 
in these, it will seem as though merely a kind of 
introduction had been given to the practical 
parts of our teaching. For the whole matter is 
as follows: Genesis, growth, and nutrition are 
the first, and, so to say, the principal effects of 
Nature; similarly also the faculties which pro- 
duce these effects the first faculties are three 
in number, and are the most dominating of all. 
But as has already been shown, these need the 
service both of each other, and of yet different 
faculties. Now, these which the faculties of gen- 
eration and growth require have been stated. 
I shall now say what ones the nutritive faculty 
requires. 

10. For I believe that I shall prove that the 
organs which have to do with the disposal of 
the nutriment, as also their faculties, exist for 



the sake of this nutritive faculty. For since the 
action of this faculty is assimilation, and it is 
impossible for anything to be assimilated by, 
and to change into anything else unless they al- 
ready possess a certain community and affinity 
in their qualities, therefore, in the first place, 
any animal cannot naturally derive nourish- 
ment from any kind of food, and secondly, 
even in the case of those from which it can do 
so, it cannot do this at once. Therefore, by rea- 
son of this law, every animal needs several or- 
gans for altering the nutriment. For in order 
that the yellow may become red, and the red 
yellow, one simple process of alteration is re- 
quired, but in order that the white may become 
black, and the black white, all the intermediate 
stages are needed. So also, a thing which is very 
soft cannot all at once become very hard, nor 
vice versa; nor, similarly can anything which 
has a very bad smell suddenly become quite 
fragrant, nor again, can the converse happen. 

How, then, could blood ever turn into bone, 
without having first become, as far as possible, 
thickened and white? And how could bread 
turn into blood without having gradually part- 
ed with its whiteness and gradually acquired 
redness? Thus it is quite easy for blood to be- 
come flesh; for, if Nature thicken it to such an 
extent that it acquires a certain consistency and 
ceases to be fluid, it thus becomes original 
newly-formed flesh; but in order that blood 
may turn into bone, much time is needed and 
much elaboration and transformation of the 
blood. Further, it is quite clear that bread, and, 
more particularly lettuce, beet, and the like, re- 
quire a great deal of alteration in order to be- 
come blood. 

This, then, is one reason why there are so 
many organs concerned in the alteration of 
food. A second reason is the nature of the su- 
perfluities. For, as we are unable to draw any 
nourishment from grass, although this is pos- 
sible for cattle, similarly we can derive nourish- 
ment from radishes, albeit not to the same ex- 
tent as from meat; for almost the whole of the 
latter is mastered by our natures; it is trans- 
formed and altered and constituted useful 
blood; but, in the radish, what is appropriate 
and capable of being altered (and that only 
with difficulty, and with much labour) is the 
very smallest part; almost the whole of it is 
surplus matter, and passes through the diges- 
tive organs, only a very little being taken up 
into the veins as blood nor is this itself en- 
tirely utilisable blood. Nature, therefore, had 
need of a second process of separation for the su- 



Galen 



per flu i tics in the veins. Moreover, these super- 
fluities need, on the one hand, certain fresh 
routes to conduct them to the outlets, so that 
they may not spoil the useful substances, and 
they also need certain reservoirs, as it were, in 
which they are collected till they reach a suf- 
ficient quantity, and are then discharged. 

Thus, then, you have discovered bodily parts 
of a second kind, consecrated in this case to the 
[removal of the] superfluities of the food. 
There is, however, also a third kind, for carry- 
ing the pabulum in every direction; these arc 
like a number of roads intersecting the whole 
body. 

Thus there is one entrance that through 
the mouth for all the various articles of food. 
What receives nourishment, however, is not 
one single part, but a great many parts, and 
these widely separated; do not be surprised, 
therefore, at the abundance of organs which 
Nature has created for the purpose of nutrition. 
For those of them which have to do with altera- 
tion prepare the nutriment suitable for each 
part; others separate out the superfluities; some 
pass these along, others store them up, others 
excrete them; some, again, are paths for the 
transit in all directions of the utilisablc juices. 
So, if you wish to gain a thorough acquaintance 
with all the faculties of Nature, you will have 
to consider each one of these organs. 

Now in giving an account of these we must 
begin with those effects of Nature, together 
with their corresponding parts and faculties, 
which are closely connected with the purpose 
to be achieved. 

u. Let us once more, then, recall the actual 
purpose for which Nature has constructed all 
these parts. Its name, as previously stated, is 
nutrition, and the definition corresponding to 
the name is: an assimilation of that which nour- 
ishes to that which receives nourishment. And 
in order that this may come about, we must 
assume a preliminary process of adhesion, and 
for that, again, one of presentation. For when- 
ever the juice which is destined to nourish any 
of the parts of the animal is emitted from the 
vessels, it is in the first place dispersed all 
through this part, next it is presented, and next 
it adheres, and becomes completely assimi- 
lated. 

The so-called white [leprosy] shows the dif- 
ference between assimilation and adhesion, in 
the same way that the kind of dropsy which 
some people call anasarca clearly distinguishes 
presentation from adhesion. For, of course, the 
genesis of such a dropsy does not come about 



as do some of the conditions of atrophy and 
wasting, from an insufficient supply of mois- 
ture; the flesh is obviously moist enough, in 
fact it is thoroughly saturated, and each of 
the solid parts of the body is in a similar condi- 
tion. While, however, the nutriment conveyed 
to the part does undergo presentation, it is still 
too watery, and is not properly transformed 
into a juice, nor has it acquired that viscous and 
agglutinative quality which results from the 
operation of innate heat; therefore, adhesion 
cannot come about, since, owing to this abun- 
danceof thin, crude liquid, the pabulum runs off 
and easily slips away from the solid parts of the 
body. In white [leprosy], again, there is adhe- 
sion of the nutriment but no real assimilation. 
From this it is clear that what I have just said 
is correct, namely, that in that part which is to 
be nourished there must first occur presenta- 
tion, next adhesion, and finally assimilation 
proper. 

Strictly speaking, then, nutriment is that 
which is actually nourishing, while the quasi- 
nutriment which is not yet nourishing (e.g. 
matter which is undergoing adhesion or presen- 
tation) is not, strictly speaking, nutriment, but 
is so called only by an equivocation. Also, that 
which is still contained in the veins, and still 
more, that which is in the stomach, from the 
fact that it is destined to nourish if properly 
elaborated, has been called "nutriment." Simi- 
larly we call the various kinds of food "nutri- 
ment," not because they are already nourishing 
the animal, nor because they exist in the same 
state as the material which actually is nourish- 
ing it, but because they are able and destined 
to nourish it if they be properly elaborated. 

This was also what Hippocrates said, viz., 
"Nutriment is what is engaged in nourishing, 
as also is quasi-nutriment, and what is destined 
to be nutriment." For to that which is already 
being assimilated he gave the name of nutri- 
ment; to the similar material which is being 
presented or becoming adherent, the name of 
quasi-nutriment; and to everything else that 
is, contained in the stomach and veins the 
name of destined nutriment. 

12. It is quite clear, therefore, that nutrition 
must necessarily be a process of assimilation of 
that which is nourishing to that which is being 
nourished. Some, however, say that this assimi- 
lation does not occur in reality, but is merely 
apparent; these are the people who think that 
Nature is not artistic, that she does not show 
forethought for the animal's welfare, and that 
she has absolutely no native powers whereby 



On the Natural Faculties 1, 10-13 



she alters some substances, attracts others, and 
discharges others. 

Now, speaking generally, there have arisen 
the following two sects in medicine and philos- 
ophy among those who have made any definite 
pronouncement regarding Nature. I speak, of 
course, of such of them as know what they are 
talking about, and who realize the logical se- 
quence of their hypotheses, and stand by them; 
as for those who cannot understand even this, 
but who simply talk any nonsense that comes 
to their tongues, and who do not remain defi- 
nitely attached cither to one sect or the other 
such people are not even worth mentioning. 

What, then, arc these sects, and what arc the 
logical consequences of their hypotheses? The 
one class supposes that all substance which is 
subject to genesis and destruction is at once con- 
tinuous and susceptible of alteration. The other 
school assumes substance to be unchangeable, 
unalterable, and subdivided into fine particles, 
which are separated from one another by empty 
spaces. 

All people, therefore, who can appreciate the 
logical sequence of an hypothesis hold that, ac- 
cording to the second teaching, there does not 
exist any substance or faculty peculiar either to 
Nature or to Soul, but that these result from the 
way in which the primary corpuscles, which 
arc unaffected by change, come together. Ac- 
cording to the first-mentioned teaching, on the 
other hand, Nature is not posterior to the cor- 
puscles, but is a long way prior to them and 
older than they; and therefore in their view it 
is Nature which puts together the bodies both 
of plants and animals; and this she does by 
virtue of certain faculties which she possesses 
these being, on the one hand, attractive and 
assimilative of what is appropriate, and, on the 
other, expulsive of what is foreign. Further, she 
skilfully moulds everything during the stage of 
genesis; and she also provides for the creatures 
after birth, employing here other faculties again, 
namely, one of affection and forethought for 
offspring, and one of sociability and friendship 
for kindred. According to the other school, none 
of these things exist in the natures [of living 
things], nor is there in the soul any original in- 
nate idea, whether of agreement or difference, 
of separation or synthesis, of justice or injustice, 
of the beautiful or ugly; all such things, they say, 
arise in us from sensation and through sensa- 
tion, and animals are steered by certain images 
and memories. 

Some of these people have even expressly de- 
clared that the soul possesses no reasoning fac- 



ulty, but that we are led like cattle by the im- 
pression of our senses, and are unable to refuse 
or dissent from anything. In their view, obvi- 
ously, courage, wisdom, temperance, and self- 
control arc all mere nonsense, we do not love 
either each other or our offspring, nor do the 
gods care anything for us. This school also de- 
spises dreams, birds, omens, and the whole of 
astrology, subjects with which we have dealt 
at greater length in another work, in which we 
discuss the views of Asclcpiades the physician. 
Those who wish to do so may familiarize them- 
selves with these arguments, and they may also 
consider at this point which of the two roads 
lying before us is the better one to take. Hip- 
pocrates took the first-mentioned. According 
to this teaching, substance is one and is subject 
to alteration; there is a consensus in the move- 
ments of air and fluid throughout the whole 
body; Nature acts throughout in an artistic and 
equitable manner, having certain faculties, by 
virtue of which each part of the body draws to 
itself the juice which is proper to it, and, hav- 
ing done so, attaches it to every portion of itself, 
and completely assimilates it; while such part 
of the juice as has not been mastered, and is not 
capable of undergoing complete alteration and 
being assimilated to the part which is being 
nourished, is got rid of by yet another (an ex- 
pulsive) faculty. 

13. Now the extent of exactitude and truth 
in the doctrines of Hippocrates may be gauged, 
not merely from the way in which his oppo- 
nents are at variance with obvious facts, but also 
from the various subjects of natural research 
themselves the functions of animals, and the 
rest. For those people who do not believe that 
there exists in any part of the animal a faculty 
for attracting its own special quality arc com- 
pelled repeatedly to deny obvious facts. For in- 
stance, Asclepiades, the physician, did this in 
the case of the kidneys. That these arc organs 
for secreting [separating out] the urine, was 
the belief not only of Hippocrates, Diodes, 
Erasistratus, Praxagoras, and all other physi- 
cians of eminence, but practically every butcher 
is aware of this, from the fact that he daily ob- 
serves both the position of the kidneys and the 
duct (termed the ureter) which runs from each 
kidney into the bladder, and from this arrange- 
ment he infers their characteristic use and fac- 
ulty. But, even leaving the butchers aside, all 
people who suffer either from frequent dysuria 
or from retention of urine call themselves "nc- 
parities," when they feel pain in the loins and 
pass sandy matter in their water. 



'74 



Galen 



I do not suppose that Asclepiades ever saw a 
stone which had been passed by one of these 
sufferers, or observed that this was preceded by 
a sharp pain in the region between kidneys and 
bladder as the stone traversed the ureter, or 
that, when the stone was passed, both the pain 
and the retention at once ceased. It is worth 
while, then, learning how his theory accounts 
for the presence of urine in the bladder, and 
one is forced to marvel at the ingenuity of a 
man who puts aside these broad, clearly visible 
routes,* and postulates others which arc nar- 
row, invisible indeed, entirely imperceptible. 
His view, in fact, is that the fluid which we 
drink passes into the bladder by being resolved 
into vapours, and that, when these have been 
again condensed, it thus regains its previous 
form, and turns from vapour into fluid. He 
simply looks upon the bladder as a sponge or a 
piece of wool, and not as the perfectly compact 
and impervious body that it is, with two very 
strong coats. For if we say that the vapours pass 
through these coats, why should they not pass 
through the peritoneum and the diaphragm, 
thus filling the whole abdominal cavity and 
thorax with water? "But," says he, "of course 
the peritoneal coat is more impervious than the 
bladder, and this is why it keeps out the va- 
pours, while the bladder admits them." Yet if 
he had ever practised anatomy, he might have 
known that theoutercoat of the bladder springs 
from the peritoneum and is essentially the same 
as it, and that the inner coat, which is peculiar 
to the bladder, is more than twice as thick as 
the former. 

Perhaps, however, it is not the thickness or 
thinness of the coats, but the situation of the 
bladder, which is the reason for the vapours 
being carried into it? On the contrary, even 
if it were probable for every other reason that 
the vapours accumulate there, yet the situation 
of the bladder would be enough in itself to 
prevent this. For the bladder is situated below, 
whereas vapours have a natural tendency to rise 
upwards; thus they would fill all the region of 
the thorax and lungs long before they came to 
the bladder. 

But why do I mention the situation of the 
bladder, peritoneum, and thorax? For surely, 
when the vapours have passed through the 
coats of the stomach and intestines, it is in the 
space between these and the peritoneum that 
they will collect and become liquefied (just as 
in dropsical subjects it is in this region that 
most of the water gathers). Otherwise the va- 

The ureters. 



pours must necessarily pass straight forward 
through everything which in any way comes in 
contact with them, and will never come to a 
standstill. But, if this be assumed, then they 
will traverse not merely the peritoneum but 
also the epigastrium, and will become dispersed 
into the surrounding air; otherwise they will 
certainly collect under the skin. 

Even these considerations, however, our pres- 
ent-day Asclepiadeans attempt to answer, de- 
spite the fact that they always get soundly 
laughed at by all who happen to be present at 
their disputations on these subjects so diffi- 
cult an evil to get rid of is this sectarian parti- 
zanship, so excessively resistant to all cleansing 
processes, harder to heal than any itch! 

Thus, one of our Sophists who is a thoroughly 
hardened disputer and as skilful a master of 
language as there ever was, once got into a dis- 
cussion with me on this subject; so far from 
being put out of countenance by any of the 
above-mentioned considerations, he even ex- 
pressed his surprise that I should try to over- 
turn obvious facts by ridiculous arguments! 
"For," said he, "one may clearly observe any 
day in the case of any bladder, that, if one fills 
it with water or air and then ties up its neck 
and squeezes it all round, it does not let any- 
thing out at any point, but accurately retains 
all its contents. And surely," said he, "if there 
were any large and perceptible channels com- 
ing into it from the kidneys the liquid would 
run out through these when the bladder was 
squeezed, in the same way that it entered?" 
Having abruptly made these and similar re- 
marks in precise and clear tones, he concluded 
by jumping up and departing leaving me as 
though I were quite incapable of finding any 
plausible answer! 

The fact is that those who are enslaved to 
their sects are not merely devoid of all sound 
knowledge, but they will not even stop to learn! 
Instead of listening, as they ought, to the rea- 
son why liquid can enter the bladder through 
the ureters, but is unable to go back again the 
same way, instead of admiring Nature's ar- 
tistic skill they refuse to learn; they even go 
so far as to scoff, and maintain that the kidneys, 
as well as many other things, have been made 
by Nature for no purpose! And some of them 
who had allowed themselves to be shown the 
ureters coming from the kidneys and becoming 
implanted in the bladder, even had the audac- 
ity to say that these also existed for no purpose; 
and others said that they were spermatic ducts, 
and that this was why they were inserted into 



On the Natural Faculties 1, 13 



'75 



the neck of the bladder and not into its cavity. 
When, therefore, we had demonstrated to them 
the real spermatic ducts entering the neck of 
the bladder lower down than the ureters, we 
supposed that, if we had not done so before, we 
would now at least draw them away from their 
false assumptions, and convert them forthwith 
to the opposite view. But even this they pre- 
sumed to dispute, and said that it was not to 
be wondered at that the semen should remain 
longer in these latter ducts, these being more 
constricted, and that it should flow quickly 
down the ducts which came from the kidneys, 
seeing that these were well dilated. We were, 
therefore, further compelled to show them in a 
still living animal, the urine plainly running 
out through the ureters into the bladder; even 
thus we hardly hoped to check their nonsensi- 
cal talk. 

Now the method of demonstration is as fol- 
lows. One has to divide the peritoneum in front 
of the ureters, then secure these with ligatures, 
and next, having bandaged up the animal, let 
him go (for he will not continue to urinate). 
After this one loosens the external bandages 
and shows the bladder empty and the ureters 
quite full and distended in fact almost on the 
point of rupturing; on removing the ligature 
from them, one then plainly sees the bladder 
becoming filled with urine. 

When this has been made quite clear, then, 
before the animal urinates, one has to tie a 
ligature round his penis and then to squeeze 
the bladder all over; still nothing goes back 
through the ureters to the kidneys. Here, then, 
it becomes obvious that not only in a dead 
animal, but in one which is still living, the 
ureters are prevented from receiving back the 
urine from the bladder. These observations hav- 
ing been made, one now loosens the ligature 
from the animal's penis and allows him to 
urinate, then again ligatures one of the ureters 
and leaves the other to discharge into the blad- 
der. Allowing, then, some time to elapse, one 
now demonstrates that the ureter which was 
ligatured is obviously full and distended on the 
side next to the kidneys, while the other one 
that from which the ligature had been taken 
is itself flaccid, but has filled the bladder with 
urine. Then, again, one must divide the full 
ureter, and demonstrate how the urine spurts 
out of it, like blood in the operation of vene- 
section; and after this one cuts through the 
other also, and both being thus divided, one 
bandages up the animal externally. Then when 
enough time seems to have elapsed, one takes 



off the bandages; the bladder will now be found 
empty, and the whole region between the in- 
testines and the peritoneum full of urine, as 
if the animal were suffering from dropsy. Now, 
if anyone will but test this for himself on an 
animal, I think he will strongly condemn the 
rashness of Asclepiades, and if he also learns 
the reason why nothing regurgitates from the 
bladder into the ureters, I think he will be per- 
suaded by this also of the forethought and art 
shown by Nature in relation to animals. 

Now Hippocrates, who was the first known 
to us of all those who have been both physicians 
and philosophers inasmuch as he was the first 
to recognize what Nature effects, expresses his 
admiration of her, and is constantly singing her 
praises and calling her "just." Alone, he says, 
she suffices for the animal in every respect, per- 
forming of her own accord and without any 
teaching all that is required. Being such, she 
has, as he supposes, certain faculties, one attrac- 
tive of what is appropriate, and another elimi- 
native of what is foreign, and she nourishes the 
animal, makes it grow, and expels its diseases 
by crisis. Therefore he says that there is in our 
bodies a concordance in the movements of air 
and fluid, and that everything is in sympathy. 
According to Asclepiades, however, nothing is 
naturally in sympathy with anything else, all 
substance being divided and broken up into in- 
harmonious elements and absurd "molecules." 
Necessarily, then, besides making countless 
other statements in opposition to plain fact, he 
was ignorant of Nature's faculties, both that 
attracting what is appropriate, and that expel- 
ling what is foreign. Thus he invented some 
wretched nonsense to explain blood-production 
and anadosis, and, being utterly unable to find 
anything to say regarding the clearing-out of 
superfluities, he did not hesitate to join issue 
with obvious facts, and, in this matter of uri- 
nary secretion, to deprive both the kidneys and 
the ureters of their activity, by assuming that 
there were certain invisible channels opening 
into the bladder. It was, of course, a grand and 
impressive thing to do, to mistrust the obvious, 
and to pin one's faith in things which could not 
be seen! 

Also, in the matter of the yellow bile, he 
makes an even grander and more spirited ven- 
ture; for he says this is actually generated in the 
bile-ducts, not merely separated out. 

How comes it, then, that in cases of jaundice 
two things happen at the same time that the 
dejections contain absolutely no bile, and that 
the whole body becomes full of it? He is forced 



176 



Galen 



here again to talk nonsense, just as he did in 
regard to the urine. He also talks no less non- 
sense about the black bile and the spleen, not 
understanding what was said by Hippocrates; 
and he attempts in stupid I might say insane 
language, to contradict what he knows noth- 
ing about. 

And what profit did he derive from these 
opinions from the point of view of treatment? 
He neither was able to cure a kidney ailment, 
nor jaundice, nor a disease of black bile, nor 
would he agree with the view held not merely 
by Hippocrates but by all men regarding drugs 
that some of them purge away yellow bile, 
and others black, some again phlegm, and 
others the thin and watery superfluity; he held 
that alt the substances evacuated were produced 
by the drugs themselves, just as yellow bile is 
produced by the biliary passages! It matters 
nothing, according to this extraordinary man, 
whether we give a hydragogue or a cholagogue 
in a case of dropsy, for these all equally purge 
and dissolve the body, and produce a solution 
having such and such an appearance, which 
did not exist as such before! 

Must we not, therefore, suppose he was either 
mad, or entirely unacquainted with practical 
medicine? For who does not know that if a 
drug for attracting phlegm be given in a case 
of jaundice it will not even evacuate four cyathi* 
of phlegm? Similarly also if one of the hydra- 
gogues be given. A cholagogue, on the other 
hand, clears away a great quantity of bile, and 
the skin of patients so treated at once becomes 
clear. I myself have, in many cases, alter treat- 
ing the liver condition, then removed the dis- 
ease by means of a single purgation; whereas, 
if one had employed a drug for removing 
phlegm one would have done no good. 

Nor is Hippocrates the only one who knows 
this to be so, whilst those who take experience 
alone as their starting-point know otherwise; 
they, as well as all physicians who are engaged 
in the practice of medicine, are of this opinion. 
Asclepiades, however, is an exception; he would 
hold it a betrayal of his assumed "elements'* to 
confess the truth about such matters. For if a 
single drug were to be discovered which at- 
tracted such and such a humour only, there 
would obviously be danger of the opinion gain- 
ing ground that there is in every body a faculty 
which attracts its own particular quality. He 
therefore says that safflower, the Cnidian berry, 
and Hippophaes, do not draw phlegm from the 
body, but actually make it. Moreover, he holds 

* About 4 oz., or one-third of a pint 



that the flower and scales of bronze, and burnt 
bronze itself, and germander, and wild mastich 
dissolve the body into water, and that dropsical 
patients derive benefit from these substances, 
not because they are purged by them, but be- 
cause they are rid of substances which actually 
help to increase the disease; for, if the medicine 
does not evacuate the dropsical fluid contained 
in the body, but generates it, it aggravates the 
condition further. Moreover, scammony, ac- 
cording to the Asclepiadean argument, not only 
fails to evacuate the bile from the bodies of 
jaundiced subjects, but actually turns the use- 
ful blood into bile, and dissolves the body; in 
fact it does all manner of evil and increases the 
disease. 

And yet this drug may be clearly seen to do 
good to numbers of people! "Yes," says he, 
"they derive benefit certainly, but merely in 
proportion to the evacuation." . . . But if you 
give these cases a drug which draws off phlegm 
they will not be benefited. This is so obvious 
that even those who make experience alone 
their starting-point are aware of it; and these 
people make it a cardinal point of their teach- 
ing to trust to no arguments, but only to what 
can be clearly seen. In this, then, they show 
good sense; whereas Asclepiades goes far astray 
in bidding us distrust our senses where obvious 
facts plainly overturn his hypotheses. Much 
better would it have been for him not to assail 
obvious facts, but rather to devote himself en- 
tirely to these. 

Is it, then, these facts only which are plainly 
irreconcilable with the views of Asclepiades? Is 
not also the fact that in summer yellow bile is 
evacuated in greater quantity by the same drugs, 
and in winter phlegm, and that in a young man 
more bile is evacuated, and in an old man more 
phlegm? Obviously each drug attracts some- 
thing which already exists, and does not gen- 
erate something previously non-existent. Thus 
if you give in the summer season a drug which 
attracts phlegm to a young man of a lean and 
warm habit, who has lived neither idly nor too 
luxuriously, you will with great difficulty evac- 
uate a very small quantity of this humour, and 
you will do the man the utmost harm. On the 
other hand, if you give him a cholagogue, you 
will produce an abundant evacuation and not 
injure him at all. 

Do we still, then, disbelieve that each drug 
attracts that humour which is proper to it? 
Possibly the adherents of Asclepiades will as- 
sent to this or rather, they will not possibly, 
but certainly declare that they disbelieve it, 



On the Natural Faculties 1, 13-14 



lest they should betray their darling prejudices. 

14. Let us pass on, then, again to another 
piece of nonsense; for the sophists do not allow 
one to engage in enquiries that are of any 
worth, albeit there are many such; they com- 
pel one to spend one's time in dissipating the 
fallacious arguments which they bring forward. 

What, then, is this piece of nonsense? It has 
to do with the famous and far-renowned stone 
which draws iron [the lodestone]. It might be 
thought that this would draw their minds to a 
belief that there arc in all bodies certain facul- 
ties by which they attract their own proper 
qualities. 

Now Epicurus, despite the fact that he cm- 
ploys in his "Physics" elements similar to those 
of Asclepiades, yet allows that iron is attracted 
by the lodestone, and chaff by amber. He even 
tries to give the cause of the phenomenon. His 
view is that the atoms which flow from the 
stone are related in shape to those flowing from 
the iron, and so they become easily interlocked 
with one another; thus it is that, after colliding 
with each of the two compact masses (the stone 
and the iron) they then rebound into the mid- 
dle and so become entangled with each other, 
and draw the iron after them. So far, then, as 
his hypotheses regarding causation go, he is 
perfectly unconvincing; nevertheless, he does 
grant that there is an attraction. Further, he 
says that it is on similar principles that there 
occur in the bodies of animals the dispersal of 
nutriment and the discharge of waste matters, 
as also the actions of cathartic drugs. 

Asclepiades, however, who viewed with sus- 
picion the incredible character of the cause 
mentioned, and who saw no other credible 
cause on the basis of his supposed elements, 
shamelessly had recourse to the statement that 
nothing is in any way attracted by anything 
else. Now, if he was dissatisfied with what 
Epicurus said, and had nothing better to say 
himself, he ought to have refrained from mak- 
ing hypotheses, and should have said that Na- 
ture is a constructive artist and that the sub- 
stance of things is always tending towards unity 
and also towards alteration because its own 
parts act upon and are acted upon by one an- 
other. For, if he had assumed this, it would not 
have been difficult to allow that this construc- 
tive Nature has powers which attract appropri- 
ate and expel alien matter. For in no other way 
could she be constructive, preservative of the 
animal, and eliminative of its diseases, unless 
it be allowed that she conserves what is appro- 
priate and discharges what is foreign. 



But in this matter, too, Asclepiades realized 
the logical sequence of the principles he had 
assumed; he showed no scruples, however, in 
opposing plain fact; he joins issue in this mat- 
ter also, not merely with all physicians, but 
with everyone else, and maintains that there 
is no such thing as a crisis, or critical day, and 
that Nature docs absolutely nothing for the pres- 
ervation of the animal. For his constant aim is 
to follow out logical consequences and to upset 
obvious fact, in this respect being opposed to 
Epicurus; for the latter always stated the ob- 
served fact, although he gives an ineffective ex- 
planation of it. For, that these small corpuscles 
belonging to the lodestone rebound, and become 
entangled with other similar particles of the 
iron, and that then, by means of this entangle- 
ment (which cannot be seen anywhere) such a 
heavy substance as iron is attracted I fail to un- 
derstand how anybody could believe this. Even 
if we admit this, the same principle will not ex- 
plain the fact that, when the iron has another 
piece brought in contact with it, this becomes 
attached to it. 

For what are we to say? That, forsooth, some 
of the particles that flow from the lodestone 
collide with the iron and then rebound back, 
and that it is by these that the iron becomes sus- 
pended? that others penetrate into it, and rap- 
idly pass through it by way of its empty chan- 
nels? that these then collide with the second 
piece of iron and arc not able to penetrate it 
although they penetrated the first piece? and 
that they then course back to the first piece, 
and produce entanglements like the former 
ones? 

The hypothesis here becomes clearly refuted 
by its absurdity. As a matter of fact, I have seen 
five writing-stylets of iron attached to one an- 
other in a line, only the first one being in con- 
tact with the lodestone, and the power being 
transmitted through it to the others. Moreover, 
it cannot be said that if you bringa second stylet 
into contact with the lower end of the first, it 
becomes held, attached, and suspended, where- 
as, if you apply it to any other part of the side 
it does not become attached. For the power of 
the lodestone is distributed in all directions; it 
merely needs to be in contact with the first 
stylet at any point; from this stylet again the 
power flows, as quick as a thought, all through 
the second, and from that again to the third. 
Now, if you imagine a small lodestone hanging 
in a house, and in contact with it all round a 
large number of pieces of iron, from them again 
others, from these others, and so on, all these 



178 



Galen 



pieces of iron must surely become filled with 
the corpuscles which emanate from the stone; 
therefore, this first little stone is likely to be- 
come dissipated by disintegrating into these 
emanations. Further, even if there be no iron 
in contact with it, it still disperses into the air, 
particularly if this be also warm. 

"Yes," says Epicurus, "but these corpuscles 
must be looked on as exceedingly small, so that 
some of them are a ten-thousandth part of the 
size of the very smallest particles carried in the 
air." Then do you venture to say that so great 
a weight of iron can be suspended by such small 
bodies? If each of them is a ten-thousandth part 
as large as the dust particles which are borne 
in the atmosphere, how big must we suppose 
the hook-like extremities by which they inter- 
lock with each other to be? For of course this 
is quite the smallest portion of the whole par- 
ticle. 

Then, again, when a small body becomes en- 
tangled with another small body, or when a 
body in motion becomes entangled with an- 
other also in motion, they do not rebound at 
once. For, further, there will of course be others 
which break in upon them from above, from 
below, from front and rear, from right and left, 
and which shake and agitate them and never 
let them rest. Moreover, we must perforce sup- 
pose that each of these small bodies has a large 
number of these hook-like extremities. For by 
one it attaches itself to its neighbours, by an- 
other the topmost one to the lodcstone, and 
by the bottom one to the iron. For if it were at- 
tached to the stone above and not interlocked 
with the iron below, this would be of no use. 
Thus, the upper part of the superior extremity 
must hang from the lodestonc, and the iron 
must be attached to the lower end of the in- 
ferior extremity; and, since they interlock with 
each other by their sides as well, they must, of 
course, have hooks there too. Keep in mind also, 
above everything, what small bodies these are 
which possess all these different kinds of out- 
growths. Still more, remember how, in order 
that the second piece of iron may become at- 
tached to the first, the third to the second, and 
to that the fourth, these absurd little particles 
must both penetrate the passages in the first 
piece of iron and at the same time rebound from 
the piece coming next in the series, although 
this second piece is naturally in every way simi- 
lar to the first. 

Such an hypothesis, once again, is certainly 
not lacking in audacity; in fact, to tell the truth, 
it is far more shameless than the previous ones; 



according to it, when five similar pieces of iron 
are arranged in a line, the particles of the lode- 
stone which easily traverse the first piece of iron 
rebound from the second, and do not pass read- 
ily through it in the same way. Indeed, it is 
nonsense, whichever alternative is adopted. For, 
if they do rebound, how then do they pass 
through into the third piece? And if they do 
not rebound, how does the second piece become 
suspended to the first? For Epicurus himself 
looked on the rebound as the active agent in 
attraction. 

But, as I have said, one is driven to talk non- 
sense whenever one gets into discussion with 
such men. Having, therefore, given a concise 
and summary statement of the matter, I wish 
to bedone with it. For if one diligently familiar- 
izes oneself with the writings of Asclepiades, 
one will see clearly their logical dependence 
on his first principles, but also their disagree- 
ment with observed facts. Thus, Epicurus, in 
his desire to adhere to the facts, cuts an awk- 
ward figure by aspiring to show that these 
agree with his principles, whereas Asclepiades 
safeguards the sequence of principles, but pays 
no attention to the obvious fact. Whoever, there- 
fore, wishes to expose the absurdity of their 
hypotheses, must, if the argument be in answer 
to Asclepiades, keep in mind his disagreement 
with observed fact; or if in answer to Epicurus, 
his discordance with his principles. Almost all 
the other sects depending on similar principles 
are now entirely extinct, while these alone main- 
tain a respectable existence still. Yet the tenets 
of Asclepiades have been unanswerably con- 
futed by Menodotus the Empiricist, who draws 
his attention to their opposition to phenomena 
and to each other; and, again, those of Epicurus 
have been confuted by Asclepiades, who ad- 
hered always to logical sequence, about which 
Epicurus evidently cares little. 

Now people of the present day do not begin 
by getting a clear comprehension of these sects, 
as well as of the better ones, thereafter devot- 
ing a long time to judging and testing the true 
and false in each of them; despite their igno- 
rance, they style themselves, some "physicians" 
and others "philosophers." No wonder, then, 
that they honour the false equally with the true. 
For everyone becomes like the first teacher that 
he comes across, without waiting to learn any- 
thing from anybody else. And there are some 
of them, who, even if they meet with more than 
one teacher, are yet so unintelligent and slow- 
witted that even by the time they have reached 
old age they arc still incapable of understand- 



On the Natural Faculties 1, 14-15 



ing the steps of an argument. ... In the old days 
such people used to be set to menial tasks. . . . 
What will be the end of it God knows! 

Now, we usually refrain from arguing with 
people whose principles are wrong from the 
outset. Still, having been compelled by the nat- 
ural course of events to enter into some kind of 
a discussion with them, we must add this fur- 
ther to what was said that it is not only ca- 
thartic drugs which naturally attract their spe- 
cial qualities, but also those which remove 
thorns and the points of arrows such as some- 
times become deeply embedded in the flesh. 
Those drugs also which draw out animal poi- 
sons or poisons applied to arrows all show the 
same faculty as does the lodestone. Thus, I my- 
self have seen a thorn which was embedded in a 
young man's foot fail to come out when we ex- 
erted forcible traction with our fingers, and yet 
come away painlessly and rapidly on the appli- 
cation of a medicament. Yet even to this some 
people will object, asserting that when the in- 
flammation is dispersed from the part the thorn 
comes away of itself, without being pulled out 
by anything. But these people seem, in the first 
place, to be unaware that there are certain drugs 
for drawing out inflammation and different 
ones for drawing out embedded substances; 
and surely if it was on the cessation of an in- 
flammation that the abnormal matters were ex- 
pelled, then all drugs which disperse inflamma- 
tions ought, ipso facto, to possess the power of 
extracting these substances as well. 

And secondly, these people seem to be un- 
aware of a still more surprising fact, namely, 
that not merely do certain medicaments draw 
out thorns and others poisons, but that of the 
latter there are some which attract the poison of 
the viper, others that of the sting-ray, and others 
that of some other animal; we can, in fact, 
plainly observe these poisons deposited on the 
medicaments. Here, then, we must praise Epi- 
curus for the respect he shows towards obvious 
facts, but find fault with his views as to causa- 
tion. For how can it be otherwise than extreme- 
ly foolish to suppose that a thorn which we 
failed to remove by digital traction could be 
drawn out by these minute particles? 

Have we now, therefore, convinced ourselves 
that everything which exists possesses a faculty 
by which it attracts its proper quality, and that 
some things do this more, and some less? 

Or shall we also furnish our argument with 
the illustration afforded by corn? For those who 
refuse to admit that anything is attracted by 
anything else, will, I imagine, be here proved 



more ignorant regarding Nature than the very 
peasants. When, for my own part, I first learn- 
ed of what happens, I was surprised, and felt 
anxious to see it with my own eyes. Afterwards, 
when experience also had confirmed its truth, 
I sought long among the various sects for an 
explanation, and, with the exception of that 
which gave the first place to attraction, I could 
find none which even approached plausibility, 
all the others being ridiculous and obviously 
quite untenable. 

What happens, then, is the following. When 
our peasants are bringing corn from the coun- 
try into the city in wagons, and wish to filch 
some away without being detected, they fill 
earthen jars with water and stand them among 
the corn; the corn then draws the moisture into 
itself through the jar and acquires additional 
bulk and weight, but the fact is never detected 
by the onlookers unless someone who knew 
about the trick before makes a more careful 
inspection. Yet, if you care to set down the same 
vessel in the very hot sun, you will find the 
daily loss to be very little indeed. Thus corn 
has a greater power than extreme solar heat of 
drawing to itself the moisture in its neighbour- 
hood. Thus the theory that the water is carried 
towards the rarefied part of the air surrounding 
us (particularly when that is distinctly warm) 
is utter nonsense; for although it is much more 
rarefied there than it is amongst the corn, yet 
it does not take up a tenth part of the moisture 
which the corn does. 

15. Since, then, we have talked sufficient non- 
sense not willingly, but because we were forc- 
ed, as the proverb says, "to behave madly among 
madmen" let us return again to the subject of 
urinary secretion. Here let us forget the absurd- 
ities of Asclepiades, and, in company with those 
who are persuaded that the urine does pass 
through the kidneys, let us consider what is the 
character of this function. For, most assuredly, 
either the urine is conveyed by its own motion 
to the kidneys, considering this the better course 
(as do we when we go off to market!), or, if 
this be impossible, then some other reason for 
its conveyance must be found. What, then, is 
this? If we are not going to grant the kidneys 
a faculty for attracting this particular quality, 
as Hippocrates held, we shall discover no other 
reason. For, surely everyone sees that either the 
kidneys must attract the urine, or the veins 
must propel it if, that is, it does not move of 
itself. But if the veins did exert a propulsive 
action when they contract, they would squeeze 
out into the kidneys not merely the urine, but 



i8o 



Galen 



along with it the whole of the blood which they 
contain. And if this is impossible, as we shall 
show, the remaining explanation is that the 
kidneys do exert traction. 

And how is propulsion by the veins impos- 
sible? The situation of the kidneys is against it. 
They do not occupy a position beneath the hol- 
low vein [vena cava] as docs the sieve-like 
[ethmoid ] passage in the nose and palate in re- 
lation to the surplus matter from the brain; they 
arc situated on both sides of it. Besides, if the 
kidneys are like sieves, and readily let the thin- 
ner serous [whey-like] portion through, and 
keep out the thicker portion, then the whole of 
the blood contained in the vena cava must go 
to them, just as the whole of the wine is thrown 
into the filters. Further, the example of milk 
being made into cheese will show clearly what 
I mean. For this, too, although it is all thrown 
into the wicker strainers, does not all percolate 
through; such part of: it as is too fine in pro- 
portion to the width of the meshes passes down- 
wards, and this is called whey [serum]; the 
remaining thick portion which is destined to 
become cheese cannot get down, since the pores 
of the strainers will not admit it. Thus it is that, 
if the blood-serum has similarly to percolate 
through the kidneys, the whole of the blood 
must come to them, and not merely one part 
of it. 

What, then, is the appearance as found on 
dissection P 

One division of the vena cava is carried up- 
wards to the heart, and the other mounts upon 
the spine and extends along its whole length 
as far as the legs; thus one division does not 
even come near the kidneys, while the other 
approaches them but is certainly not inserted 
into them. Now, if the blood were destined to 
be purified by them as if they were sieves, the 
whole of it would have to fall into them, the 
thin part being thereafter conveyed downwards, 
and the thick part retained above. But, as a mat- 
ter of fact, this is not so. For the kidneys lie on 
either side of the vena cava. They therefore do 
not act like sieves, filtering fluid sent to them 
by the vena cava, and themselves contributing 
no force. They obviously exert traction; for this 
is the only remaining alternative. 

How, then, do they exert this traction? If, as 
Epicurus thinks, all attraction takes place by 
virtue of the rebounds and entanglements of 
atoms, it would be certainly better to maintain 
that the kidneys have no attractive action at 
all; for his theory, when examined, would be 
found as it stands to be much more ridiculous 



even than the theory of the lodcstone, mention- 
ed a little while ago. Attraction occurs in the 
way that Hippocrates laid down; this will be 
stated more clearly as the discussion proceeds; 
for the present our task is not to demonstrate 
this, but to point out that no other cause of the 
secretion of urine can be given except that of 
attraction by the kidneys, and that this attrac- 
tion does not take place in the way imagined 
by people who do not allow Nature a faculty 
of her own. 

For if it be granted that there is any attrac- 
tive faculty at all in those things which are 
governed by Nature, a person who attempted 
to say anything else about the absorption of 
nutriment would be considered a fool. 

1 6. Now, while Erasistratus for some reason 
replied at great length to certain other foolish 
doctrines, he entirely passed over the view held 
by Hippocrates, not even thinking it worth 
while to mention it, as he did in his work 
"On Deglutition"; in that work, as may be 
seen, he did go so far as at least to make men- 
tion of the word attraction, writing somewhat 
as follows: 

"Now, the stomach does not appear to exer- 
cise any attraction." But when he is dealing 
with anadosis he does not mention the Hippo- 
cratic view even to the extent of a single sylla- 
ble. Yet we should have been satisfied if he had 
even merely written this: "Hippocrates lies in 
saying The flesh* attracts both from the stom- 
ach and from without,* for it cannot attract 
either from the stomach or from without." Or 
if he had thought it worth while to state that 
Hippocrates was wrong in criticizing the weak- 
ness of the neck of the uterus, "seeing that the 
orifice of the uterus has no power of attracting 
semen," or if he [Erasistratus] had thought 
proper to write any other similar opinion, then 
we in our turn would have defended ourselves 
in the following terms: 

"My good sir, do not run us down in this 
rhetorical fashion without some proof; state 
some definite objection to our view, in order 
that either you may convince us by a brilliant 
refutation of the ancient doctrine, or that, on 
the other hand, we may convert you from your 
ignorance." Yet why do I say "rhetorical"? For 
we too are not to suppose that when certain 
rhetoricians pour ridicule upon that which they 
are quite incapable of refuting, without any at- 
tempt at argument, their words are really there- 
by constituted rhetoric. For rhetoric proceeds 
by persuasive reasoning; words without rcason- 

* i.e. the tissues. 



On the Natural Faculties 1, 15-16 



ing arc buffoonery rather than rhetoric. There- 
fore, the reply of Erasistratus in his treatise 
"On Deglutition" was neither rhetoric nor logic. 
For what is it that he says? "Now, the stomach 
does not appear to exercise any traction." Let 
us testify against him in return, and set our 
argument beside his in the same form. Now, 
there appears to be no peristalsis of the gullet. 
"And how does this appear?" one of his ad- 
herents may perchance ask. "For is it not indic- 
ative of peristalsis that always when the upper 
parts of the gullet contract the lower parts di- 
late?" Again, then, we say, "And in what way 
does the attraction of the stomach not appear? 
For is it not indicative of attraction that always 
when the lower parts of the gullet dilate the 
upper parts contract?" Now, if he would but be 
sensible and recognize that this phenomenon is 
not more indicative of the one than of the other 
view, but that it applies equally to both, we 
should then show him without further delay 
the proper way to the discovery of truth. 

We will, however, speak about the stomach 
again. And the dispersal of nutriment [ana- 
dosis] need not make us have recourse to the 
theory regarding the natural tendency of a 
vacuum to become refilled, when once we have 
granted the attractive faculty of the kidneys. 
Now, although Erasistratus knew that this fac- 
ulty most certainly existed, he neither men- 
tioned it nor denied it, nor did he make any 
statement as to his views on the secretion of 
urine. 

Why did he give notice at the very beginning 
of his "General Principles" that he was going 
to speak about natural activities firstly what 
they are, how they take place, and in what situa- 
tions and then, in the case of urinary secre- 
tion, declared that this took place through the 
kidneys, but left out its method of occurrence? 
It must, then, have been for no purpose that he 
told us how digestion occurs, or spends time up- 
on the secretion of biliary superfluities; for in 
these cases also it would have been sufficient to 
have named the parts through which the func- 
tion takes place, and to have omitted the method. 
On the contrary, in these cases he was able to 
tell us not merely through what organs, but also 
in what way it occurs as he also did, I think, 
in the case of anadosis; for he was not satisfied 
with saying that this took place through the 
veins, but he also considered fully the method, 
which he held to be from the tendency of a 
vacuum to become refilled. Concerning the se- 
cretion of urine, however, he writes that this 
occurs through the kidneys, but docs not add 



181 

in what way it occurs. I do not think he could 
say that this was from the tendency of matter 
to fill a vacuum, for, if this were so, nobody 
would have ever died of retention of urine, since 
no more can flow into a vacuum than has run 
out. For, if no other factor comes into opera- 
tion save only this tendency by which a vacuum 
becomes refilled, no more could ever flow in 
than had been evacuated. Nor could he suggest 
any other plausible cause, such, for example, 
as the expression of nutriment by the stomach 
which occurs in the process of anadosis; this had 
been entirely disproved in the case of blood in 
the vena cava; it is excluded, not merely owing 
to the long distance, but also from the fact that 
the overlying heart, at each diastole, robs the 
vena cava by violence of a considerable quantity 
of blood. 

In relation to the lower part of the vena cava 
there would still remain, solitary and aban- 
doned, the specious theory concerning the fill- 
ing of a vacuum. This, however, is deprived of 
plausibility by the fact that people die of reten- 
tion of urine, and also, no less, by the situation 
of the kidneys. For, if the whole of the blood 
were carried to the kidneys, one might properly 
maintain that it all undergoes purification there. 
But, as a matter of fact, the whole of it does not 
go to them, but only so much as can be con- 
tained in the veins going to the kidneys; this 
portion only, therefore, will be purified. Fur- 
ther, the thin serous part of this will pass 
through the kidneys as if through a sieve, 
while the thick sanguineous portion remaining 
in the veins will obstruct the blood flowing in 
from behind; this will first, therefore, have to 
run back to the vena cava, and so to empty the 
veins going to the kidneys; these veins will no 
longer be able to conduct a second quantity of 
unpurified blood to the kidneys occupied as 
they are by the blood which had preceded, there 
is no passage left. What power have we, then, 
which will draw back the purified blood from 
the kidneys? And what power, in the next place, 
will bid this blood retire to the lower part of the 
vena cava, and will enjoin on another quantity 
coming from above not to proceed downwards 
before turning off into the kidneys? 

Now Erasistratus realized that all these ideas 
were open to many objections, and he could on- 
ly find one idea which held good in all respects 
namely, that of attraction. Since, therefore, 
he did not wish either to get into difficulties or 
to mention the view of Hippocrates, he deemed 
it better to say nothing at all as to the manner 
in which secretion occurs. 



Galen 



But even if he kept silence, I am not going to 
do so. For I know that if one passes over the 
Hippocratic view and makes some other pro- 
nouncement about the function of the kidneys, 
one cannot fail to make oneself utterly ridicu- 
lous. It was for this reason that Erasistratus kept 
silence and Asclepiadcs lied; they arc like slaves 
who have had plenty to say in the early part of 
their career, and have managed by excessive 
rascality to escape many and frequent accusa- 
tions, but who, later, when caught in the act of 
thieving, cannot find any excuse; the more mod- 
est one then keeps silence, as though thunder- 
struck, whilst the more shameless continues to 
hide the missing article beneath his arm and 
denies on oath that he has ever seen it. For it 
was in this way also that Asclepiades, when all 
subtle excuses had failed him and there was no 
longer any room for nonsense about "convey- 
ance towards the rarefied part [of the air]/' 
and when it was impossible without incurring 
the greatest derision to say that this superfluity 
[i.e. the urine] is generated by the kidneys as is 
bile by the canals in the liver he, then, I say, 
clearly lied when he swore that the urine docs 
not reach the kidneys, and maintained that it 
passes, in the form of vapour, straight from the 
region of the vena cava,to collect in the bladder. 

Like slaves, then,caught in the act of stealing, 
these two are quite bewildered, and while the 
one says nothing, the other indulges in shame- 
less lying. 

17. Now such of the younger men as have 
dignified themselves with the names of these 
two authorities by taking the appellations 
"Erasistrateans"or"Asclepiadeans"are like the 
Davi and Getae the slaves introduced by the 
excellent Mcnander into his comedies. As these 
slaves held that they had done nothing fine un- 
less they had cheated their master three times, 
so also the men I am discussing have taken their 
time over the construction of impudent soph- 
isms, the one party striving to prevent the lies 
of Asclepiadcs from ever being refuted, and the 
other saying stupidly what Erasistratus had the 
sense to keep silence about. 

But enough about the Asclepiadeans. The 
Erasistratcans, in attempting to say how the 
kidneys let the urine through, will do anything 
or suffer anything or try any shift in order to 
find some plausible explanation which does not 
demand the principle of attraction. 

Now those near the times of Erasistratus 
maintain that the parts above the kidneys re- 
ceive pure blood, whilst the watery residue, 
being heavy, tends to run downwards; that 



this, after percolating through the kidneys 
themselves, is thus rendered serviceable, and 
is sent, as blood, to all the parts below the 
kidneys. 

For a certain period at least this view also 
found favour and flourished, and was held to 
be true; after a time, however, it became sus- 
pect to the Erasistrateans themselves, and at last 
they abandoned it. For apparently the following 
two points were assumed, neither of which is 
conceded by anyone, nor is even capable of be- 
ing proved. The first is the heaviness of the se- 
rous fluid, which was said to be produced in the 
vena cava, and which did not exist, apparently, 
at the beginning, when this fluid was being car- 
ried up from the stomach to the liver. Why, 
then, did it not at once run downwards when 
it was in these situations? And if the watery 
fluid is so heavy, what plausibility can anyone 
find in the statement that it assists in the proc- 
ess of anadosis? 

In the second place there is this absurdity, 
that even if it be agreed that all the watery fluid 
does fall downwards, and only when it is in 
the vena cava, still it is difficult, or, rather, im- 
possible, to say through what means it is going 
to fall into the kidneys, seeing that these are not 
situated below, but on either side of the vena 
cava, and that the vena cava is not inserted into 
them, but merely sends a branch into each of 
them, as it also does into all the other parts. 

What doctrine, then, took the place of this 
one when it was condemned? One which to me 
seems far more foolish than the first, although 
it also flourished at one time. For they say, that 
if oil be mixed with water and poured upon the 
ground, each will take a different route, the one 
flowing this way and the other that, and that, 
therefore, it is not surprising that the watery 
fluid runs into the kidneys, while the blood 
falls downwards along the vena cava. Now this 
doctrine also stands already condemned. For 
why, of the countless veins which spring from 
the vena cava, should blood flow into all the 
others, and the serous fluid be diverted to those 
going to the kidneys? They have not answered 
the question which was asked; they merely state 
what happens and imagine they have thereby 
assigned the reason. 

Once again, then (the third cup to the Sav- 
iour!),* let us now speak of the worst doctrine 
of all, lately invented by Lycus of Macedonia, 
but which is popular owing to its novelty. This 
Lycus, then, maintains, as though uttering an 

* In a toast, the third cup was drunk to Zeus 
Soter (the Saviour). 



On the Natural Faculties 1, 16-17, II, i 



oracle from the inner sanctuary, that urine is 
residual matter from the nutrition of the kid- 
neys! Now, the amount of urine passed every 
day shows clearly that it is the whole of the fluid 
drunk which becomes urine, except for that 
which comes away with the dejections or passes 
off as sweat or insensible perspiration. This is 
most easily recognized in winter in those who 
are doing no work but are carousing, especially 
if the wine be thin and diffusible; these people 
rapidly pass almost the same quantity as they 
drink. And that even Erasistratus was aware of 
this is known to those who have read the first 
book of his "General Principles/* Thus Lycus 
is speaking neither good Erasistratism, nor good 
Asclepiadism, far less good Hippocratism. He 
is, therefore, as the saying is, like a white crow, 
which cannot mix with the genuine crows ow- 
ing to its colour, nor with the pigeons owing to 
its size. For all this, however, he is not to be 
disregarded; he may, perhaps, be stating some 
wonderful truth, unknown to any of his prede- 
cessors. 

Now it is agreed that all parts which are un- 
dergoing nutrition produce a certain amount of 
residue, but it is neither agreed nor is it likely, 
that the kidneys alone, small bodies as they are, 
could hold four whole congri, * and sometimes 
even more, of residual matter. For this surplus 
must necessarily be greater in quantity in each 
of the larger viscera; thus, for example, that of 
the lung, if it corresponds in amount to the size 
of the viscus,will obviously be many times more 
than that in the kidneys, and thus the whole of 
the thorax will become filled, and the animal 

* About twelve quarts. 



will be at once suffocated. But if it be said that 
the residual matter is equal in amount in each 
of the other parts, where arc the bladders, one 
may ask, through which it is excreted? For, if 
the kidneys produce in drinkers three and some- 
times four congii of superflous matter, that of 
each of the other viscera will be much more, and 
thus an enormous barrel will be needed to con- 
tain the waste products of them all. Yet one of- 
ten urinates practically the same quantity as one 
has drunk, which would show that the whole 
of what one drinks goes to the kidneys. 

Thus the author of this third piece of trickery 
would appear to have achieved nothing, but to 
have been at once detected, and there still re- 
mains the original difficulty which was insolu- 
ble by Erasistratus and by all others except 
Hippocrates. I dwell purposely on this topic, 
knowing well that nobody else has anything to 
say about the function of the kidneys, but that 
either we must prove more foolish than the very 
butchers if we do not agree that the urine passes 
through the kidneys; or, if one acknowledges 
this, that then one cannot possibly give any 
other reason for the secretion than the principle 
of attraction. 

Now, if the movement of urine docs not de- 
pend on the tendency of a vacuum to become 
refilled, it is clear that neither docs that of the 
blood nor that of the bile; or if that of these 
latter does so, then so also does that of the 
former. For they must all be accomplished in 
one and the same way, even according to Er- 
asistratus himself. 

This matter, however, will be discussed more 
fully in the book following this. 



Book Two 



i. In the previous book we demonstrated that 
not only Erasistratus, but also all others who 
would say anything to the purpose about uri- 
nary secretion, must acknowledge that the kid- 
neys possess some faculty which attracts to them 
this particular quality existing in the urine. Be- 
sides this we drew attention to the fact that the 
urine is not carried through the kidneys into 
the bladder by one method, the blood into parts 
of the animal by another, and the yellow bile 
separated out on yet another principle. For when 
once there has been demonstrated in any one 
organ, the drawing, or so-called epi spastic fac- 
ulty, there is then no difficulty in transferring 
it to the rest. Certainly Nature did not give a 



power such as this to the kidneys without giv- 
ing it also to the vessels which abstract the bil- 
iary fluid,* nor did she give it to the latter with- 
out also giving it to each of the other parts. And, 
assuredly, if this is true, we must marvel that 
Erasistratus should make statements concern- 
ing the delivery of nutriment from the food- 
canal which are so false as to be detected even 
by Asclcpiades. Now, Erasistratus considers it 
absolutely certain that, if anything flows from 
the veins, one of two things must happen: ci- 
ther a completely empty space will result, or 

* The radicles of the hepatic ducts in the liver 
were supposed to be the active agents in extract- 
ing bile from the blood. 



Galen 



the contiguous quantum of fluid will run in and 
take the place or that which has been evacuated. 
A sclepiades, however, holds that not one of two, 
but one of three things must be said to result in 
the emptied vessels: either there will be an en- 
tirely empty space, or the contiguous portion 
will flow in, or the vessel will contract. For 
whereas, in the case of reeds and tubes it is true 
to say that, if these be submerged in water, and 
are emptied of the air which they contain in 
their lumens, then either a completely empty 
space will be left, or the contiguous portion will 
move onwards; in the case of veins this no long- 
er holds, since their coats can collapse and so 
fall in upon the interior cavity. It may be seen, 
then, how false this hypothesis by Zeus, I can- 
not call it a demonstration! of Erasistratus is. 

And, from another point of view, even if it 
were true, it is superfluous, if the stomach has 
the power of compressing the veins, as he him- 
self supposed, and the veins again of contracting 
upon their contents and propelling them for- 
wards. For, apart from other considerations, no 
plethora would ever take place in the body, if 
delivery of nutriment resulted merely from the 
tendency of a vacuum to become refilled. Now, 
if the compression of the stomach becomes 
weaker the further it goes, and cannot reach to 
an indefinite distance, and if, therefore, there is 
need of some other mechanism to explain why 
the blood is conveyed in all directions, then the 
principle of the refilling of a vacuum may be 
looked on as a necessary addition; there will not, 
however, be a plethora in any of the parts com- 
ing after the liver, or, if there be, it will be in 
the region of the heart and lungs; for the heart 
alone of the parts which come after the liver 
draws the nutriment into its right ventricle, 
thereafter sending it through thearterioid vein * 
to the lungs (for Erasistratus himself will have 
it that, owing to the membranous excrescences., 
no other parts save the lungs receive nourish- 
ment from the heart). If, however, in order to 
explain how plethora comes about, we suppose 
the force of compression by the stomach to per- 
sist indefinitely, we have no further need of the 
principle of the refilling of a vacuum, especial- 
ly if we assume contraction of the veins in ad- 
dition as is, again, agreeable to Erasistratus 
himself. 

2. Let me draw his attention, then, once a- 
gain, even if he does not wish it, to the kidneys, 
and let me state that these confute in the very 
clearest manner such people as object to the 
principle of attraction . Nobody has ever said any- 

* What we now call the pulmonary artery. 



thing plausible, nor, as we previously showed, 
has anyone been able to discover, by any means, 
any other cause for the secretion of urine; we 
necessarily appear mad if we maintain that the 
urine passes into the kidneys in the form of va- 
pour, and we certainly cut a poor figure when 
we talk about the tendency of a vacuum to be- 
come refilled; this idea is foolish in the case of 
blood, and impossible, nay, perfectly nonsensi- 
cal, in the case of the urine. 

This, then, is one blunder made by those who 
dissociate themselves from the principle of at- 
traction. Another is that which they make about 
the secretion of yellow bile. For in this case, too, 
it is not a fact that when the blood runs past 
the mouths [stomata] of the bile-ducts there 
will be a thorough separation out [secretion] of 
biliary waste-matter. "Well," say they, "let us 
suppose that it is not secreted but carried with 
the blood all over the body." But, you sapient 
folk, Erasistratus himself supposed that Nature 
took thought for the animals' future, and was 
workmanlike in her method', and at the same 
time he maintained that the biliary fluid was 
useless in every way for the animals. Now these 
two things are incompatible. For how could 
Nature be still looked on as exercising fore- 
thought for the animal when she allowed a 
noxious humour such as this to be carried off 
and distributed with the blood? . . . 

This, however, is a small matter. I shall a- 
gain point out here the greatest and most ob- 
vious error. For if the yellow bile adjusts itself 
to the narrower vessels and stomata, and the 
blood to the wider ones, for no other reason 
than that blood is thicker and bile thinner, and 
that the stomata of the veins are wider and 
those of the bile-ducts narrower, then it is clear 
that this watery and serous superfluity,! too, 
will run out into the bile-ducts quicker than 
does the bile, exactly in proportion as it is thin- 
ner than the bile! How is it, then, that it does 
not run out? "Because," it may be said, "urine 
is thicker than bile!" This was what one of our 
Erasistrateans ventured to say, herein clearly 
disregarding the evidence of his senses, although 
he had trusted these in the case of the bile and 
blood. For, if it be that we are to look on bile as 
thinner than blood because it runs more, then, 
since the serous residue t passes through fine 
linen or lint or a sieve more easily even than does 
bile, by these tokens bile must also be thicker 
than the watery fluid. For here, again, there is 
no argument which will demonstrate that bile 
is thinner than the serous superfluities. 

t Urine, or, more exactly, blood-scrum. 



On the Natural Faculties II, 1-3 



185 



But when a man shamelessly goes on using 
circumlocutions, and never acknowledges when 
he has had a fall, he is like the amateur wres- 
tlers, who, when they have been overthrown by 
the experts and are lying on their backs on the 
ground, so far from recognizing their fall, ac- 
tually seize their victorious adversaries by the 
necks and prevent them from getting away, 
thus supposing themselves to be the winners! 

3. Thus, every hypothesis of channels as an 
explanation of natural functioning is perfect 
nonsense. For, if there were not an inborn fac- 
ulty given by Nature to each one of the organs 
at the very beginning, then animals could not 
continue to live even for a few days, far less for 
the number of years which they actually do. For 
let us suppose they were under no guardian- 
ship, lacking in creative ingenuity and fore- 
thought; let us suppose they were steered only 
by material forces, and not by any special fac- 
ulties (the one attracting what is proper to it, 
another rejecting what is foreign, and yet an- 
other causing alteration and adhesion of the 
matter destined to nourish it); if we suppose 
this, I am sure it would be ridiculous for us to 
discuss natural, or, still more, psychical, activi- 
ties or, in fact, life as a whole. 

For there is not a single animal which could 
live or endure for the shortest time if, possess- 
ing within itself so many different parts, it did 
not employ faculties which were attractive of 
what is appropriate, eliminative of what is for- 
eign, and alterative of what is destined for nu- 
trition. On the other hand, if we have these fac- 
ulties, we no longer need channels, little or big, 
resting on an unproven hypothesis, for explain- 
ing the secretion of urine and bile, and the con- 
ception of some favourable situation (in which 
point alone Erasistratus shows some common 
sense, since he does regard all the parts of the 
body as having been well sftid truly placed and 
shaped by Nature). 

But let us suppose he remained true to his 
own statement that Nature is "artistic" this 
Nature which, at the beginning, well and truly 
shaped and disposed all the parts of the animal, 
and, after carrying out this function (for she 
left nothing undone), brought it forward to 
the light of day, endowed with certain faculties 
necessary for its very existence, and, thereafter, 
gradually increased it until it reached its due 
size. If he argued consistently on this principle, 
I fail to see how he can continue to refer nat- 
ural functions to the smallness or largeness of 
canals, or to any other similarly absurd hypoth- 
esis. For this Nature which shapes and gradu- 



ally adds to the parts is most certainly extended 
throughout their whole substance. Yes indeed, 
she shapes and nourishes and increases them 
through and through, not on the outside only. 
For Praxiteles and Phidias and all the other stat- 
uaries used merely to decorate their material 
on the outside, in so far as they were able to 
touch it; but its inner parts they left unembel- 
lished, unwrought, unaffected by art or fore- 
thought, since they were unable to penetrate 
therein and to reach and handle all portions of 
the material. It is not so, however, with Nature. 
Every part of a bone she makes bone, every part 
of the flesh she makes flesh, and so with fat and 
all the rest; there is no part which she has not 
touched, elaborated, and embellished. Phidias, 
on the other hand, could not turn wax into ivo- 
ry and gold, nor yet gold into wax: for each of 
these remains as it was at the commencement, 
and becomes a perfect statue simply by being 
clothed externally in a form and artificial shape. 
But Nature does not preserve the original char- 
acter of any kind of matter; if she did so, then 
all parts of the animal would be blood that 
blood, namely, which flows to the semen from 
the impregnated female and which is, so to 
speak, like the statuary's wax, a single uniform 
matter, subjected to the artificer. From this blood 
there arises no part of the animal which is as 
red and moist [as blood is], for bone, artery, 
vein, nerve, cartilage, fat, gland, membrane, and 
marrow are not blood, though they arise from it. 

I would then ask Erasistratus himself to in- 
form me what the altering, coagulating, and 
shaping agent is. He would doubtless say, "Ei- 
ther Nature or the semen," meaning the same 
thing in both cases, but explaining it by differ- 
ent devices. For that which was previously se- 
men, when it begins to procreate and to shape 
the animal, becomes, so to say, a special nature. 
For in the same way that Phidias possessed the 
faculties of his art even before touching his ma- 
terial, and then activated these in connection 
with this material (for every faculty remains in- 
operative in the absence of its proper material), 
so it is with the semen: its faculties it possessed 
from the beginning,* while its activities it does 
not receive from its material, but it manifests 
them in connection therewith. 

And, of course, if it were to be overwhelmed 
with a great quantity of blood, it would perish, 
while if it were to be entirely deprived of blood 
it would remain inoperative and would not turn 
into a nature. Therefore, in order that it may 

* Galen attributed to the semen what we should 
to the fertilized ovum. 



i86 



Galen 



not perish, but may become a nature in place of 
semen, there must be an afflux to it of a little 
blood or, rather, one should not say a little, 
but a quantity commensurate with that of the 
semen. What is it then that measures the quan- 
tity of this afflux? What prevents more from 
coming? What ensures against a deficiency? 
What is this third overseer of animal genera- 
tion that we arc to look for, which will furnish 
the semen with a due amount of blood? What 
would Erasistratus have said if he had been 
alive, and had been asked this question? Obvi- 
ously, the semen itself. This, in fact, is the arti- 
ficer analogous with Phidias, whilst the blood 
corresponds to the statuary's wax. 

Now, it is not for the wax to discover for it- 
self how much of it is required; that is the busi- 
ness of Phidias. Accordingly the artificer will 
draw to itself as much blood as it needs. Here, 
however, we must pay attention and take care 
not unwittingly to credit the semen with rea- 
son and intelligence; if we were to do this, we 
would be making neither semen nor a nature, 
but an actual living animal. And if we retain 
these two principles that of proportionate at- 
traction and that of the non-participation of in- 
telligence we shall ascribe to the semen a fac- 
ulty for attracting blood similar to that pos- 
sessed by the lodestone for iron. Here, then, 
again, in the case of the semen, as in so many 
previous instances, we have been compelled to 
acknowledge some kind of attractive faculty. 

And what is the semen? Clearly the active 
principle of the animal, the material principle 
being the menstrual blood. Next, seeing that 
the active principle employs this faculty pri- 
marily, therefore, in order that any one of the 
things fashioned by it may come into existence, 
it [the principle] must necessarily be possessed 
of its own faculty. How, then, was Erasistratus 
unaware of it, if the primary function of the 
semen be to draw to itself a due proportion of 
blood? Now, this fluid would be in due propor- 
tion if it were so thin and vaporous, that, as soon 
as it was drawn like dew into every part of the 
semen, it would everywhere cease to display its 
own particular character; for so the semen will 
easily dominate and quickly assimilate it in 
fact, will use it as food. It will then, 1 imagine, 
draw to itself a second and a third quantum, 
and thus by feeding it acquires for itself con- 
siderable bulk and quantity. In fact, the altera- 
tive faculty has now been discovered as well, al- 
though about this also Erasistratus has not writ- 
ten a word. And, thirdly the shaping faculty 
will become evident, by virtue of which the se- 



men firstly surrounds itself with a thin mem- 
brane like a kind of superficial condensation; 
this is what was described by Hippocrates in 
the sixth-day birth, which, according to his state- 
ment, fell from the singing-girl and resembled 
the pellicle of an egg. And following this all the 
other stages will occur, such as are described by 
him in his work "On the Child's Nature." 

But if each of the parts formed were to re- 
main as small as when it first came into exist- 
ence, of what use would that be? They have, 
then, to grow. Now, how will they grow? By 
becoming extended in all directions and at the 
same time receiving nourishment. And if you 
will recall what I previously said about the blad- 
der which the children blew up and rubbed, you 
will also understand my meaning better as ex- 
pressed in what I am now about to say. 

Imagine the heart to be, at the beginning, so 
small as to differ in no respect from a millet-seed, 
or, if you will, a bean; and consider how other- 
wise it is to become large than by being extend- 
ed in all directions and acquiring nourishment 
throughout its whole substance, in the way that, 
as I showed a short while ago, the semen is 
nourished. But even this was unknown to Er- 
asistratus the man who sings the artistic skill 
of Nature! He imagines that animals grow like 
webs, ropes, sacks, or baskets, each of which 
has, woven on to its end or margin, other ma- 
terial similar to that of which it was originally 
composed. 

But this, most sapient sir, is not growth, but 
genesis! For a bag, sack, garment, house, ship, 
or the like is said to be still coming into exist- 
ence [undergoing genesis] so long as the appro- 
priate form for the sake of which it is being 
constructed by the artificer is still incomplete. 
Then, when does it grow? Only when the bas- 
ket, being complete, with a bottom, a mouth, 
and a belly, as it were, as well as the intermedi- 
ate parts, now becomes larger in all these re- 
spects. "And how can this happen?" someone 
will ask. Only by our basket suddenly becoming 
an animal or a plant; for growth belongs to liv- 
ing things alone. Possibly you imagine that a 
house grows when it is being built, or a basket 
when being plaited, or a garment when being 
woven? It is not so, however. Growth belongs 
to that which has already been completed in re- 
spect to its form, whereas the process by which 
that which is still becoming attains its form is 
termed not growth but genesis. That which is, 
grows, while that which is not, becomes. 

4. This also was unknown to Erasistratus, 
whom nothing escaped, if his followers speak 



On the Natural Faculties II, 3-4 



in any way truly in maintaining that he was fa- 
miliar with the Peripatetic philosophers. Now, 
in so far as he acclaims Nature as being an art- 
ist in construction, even I recognize the Peripa- 
tetic teachings, but in other respects he does not 
come near them. For if anyone will make him- 
self acquainted with the writings of Aristotle 
and Theophrastus, these will appear to him to 
consist of commentaries on the Nature-lore 
[physiology] of Hippocrates according to 
which the principles of heat, cold, dryness and 
moisture act upon and are acted upon by one an- 
other, the hot principle being the most active, 
and the cold coming next to it in power; all this 
was stated in the first place by Hippocrates and 
secondly by Aristotle. Further, it is at once the 
Hippocratic and the Aristotelian teaching that 
the parts which are being nourished receive that 
nourishment throughout their whole substance, 
and that, similarly, processes of mingling and 
alteration involve the entire substance. More- 
over, that digestion is a species ot alteration a 
transmutation of the nutriment into the proper 
quality of the thing receiving it; that blood- 
production also is an alteration, and nutrition 
as well; that growth results from extension in 
all directions, combined with nutrition; that al- 
teration is effected mainly by the warm princi- 
ple, and that therefore digestion, nutrition, and 
the generation of the various humours, as well 
as the qualities of the surplus substances, re- 
sult from the innate heat; all these and many 
other points besides in regard to the aforesaid 
faculties, the origin of diseases, and the discov- 
ery of remedies, were correctly stated first by 
Hippocrates of all writers whom we know, and 
were in the second place correctly expounded 
by Aristotle. Now, if all these views meet with 
the approval of the Peripatetics, as they un- 
doubtedly do, and if none of them satisfy Era- 
sistratus, what can the Erasistrateans possibly 
mean by claiming that their leader was associ- 
ated with these philosophers? The fact is, they 
revere him as a god, and think that everything 
he says is true. If this be so, then we must sup- 
pose the Peripatetics to have strayed very far 
from truth, since they approve of none of the 
ideas of Erasistratus. And, indeed, the disciples 
of the latter produce his connection with the 
Peripatetics in order to furnish his Nature-lore 
with a respectable pedigree. 

Now, let us reverse our argument and put it 
in a different way from that which we have just 
employed. For if the Peripatetics were correct 
in their teaching about Nature, there could be 
nothing more absurd than the contentions of 



Erasistratus. And, I will leave it to the Erasis- 
trateans themselves to decide; they must either 
advance the one proposition or the other. Ac- 
cording to the former one the Peripatetics had 
no accurate acquaintance with Nature, and ac- 
cording to the second, Erasistratus. It is my task, 
then, to point out the opposition between the 
two doctrines, and theirs to make the choice. . . , 

But they certainly will not abandon their rev- 
erence for Erasistratus. Very well, then; let them 
stop talking about the Peripatetic philosophers. 
For among the numerous physiological teach- 
ings regarding the genesis and destruction of 
animals, their health, their diseases, and the 
methods of treating these, there will be found 
one only which is common to Erasistratus and 
the Peripatetics namely, the view that Nature 
does everything for some purpose, and nothing 
in vain. 

But even as regards this doctrine their agree- 
ment is only verbal; in practice Erasistratus 
makes havoc of it a thousand times over. For, 
according to him, the spleen was made for no 
purpose, as also the omentum; similarly, too, 
the arteries which are inserted into kidneys 
although these arc practically the largest of all 
those that spring from the great artery [aorta] ! 
And to judge by the Erasistratean argument, 
there must be countless other useless structures; 
for, if he knows nothing at all about these struc- 
tures, he has little more anatomical knowledge 
than a butcher, while, if he is acquainted with 
them and yet does not state their use, he clear- 
ly imagines that they were made for no purpose, 
like the spleen. Why, however, should I discuss 
these structures fully, belonging as they do to 
the treatise "On the Use of Parts/' which I am 
personally about to complete? 

Let us, then, sum up again this same argu- 
ment, and, having said a few words more in 
answer to the Erasistrateans, proceed to our next 
topic. The fact is, these people seem to me to 
have read none of Aristotle's writings, but to 
have heard from others how great an authority 
he was on "Nature," and that those of the 
Porch follow in the steps of his Nature-lore; ap- 
parently they then discovered a single one of the 
current ideas which is common to Aristotle and 
Erasistratus, and made up some story of a con- 
nection between Erasistratus and these people. 
That Erasistratus, however, has no share in the 
Nature-lore of Aristotle is shown by an enu- 
meration of the aforesaid doctrines, which ema- 
nated first from Hippocrates, secondly from 
Aristotle, thirdly from the Stoics (with a single 
modification, namely, that for them the quali- 



i88 



Galen 



ties arc bodies). Perhaps, however, they will 
maintain that it was in the matter of logic that 
Erasistratus associated himself with the Peri- 
patetic philosophers? Here they show ignor- 
ance of the fact that these philosophers never 
brought forward false or inconclusive argu- 
ments, while the Erasistratean books are full 
of them. 

So perhaps somebody may already be asking, 
in some surprise, what possessed Erasistratus 
that he turned so completely from the doctrines 
of Hippocrates, and why it is that he takesaway 
the attractive faculty from the biliary passages 
in the liver for we have sufficiently discussed 
the kidneys alleging [as the cause of bile-se- 
cretion] a favourable situation, the narrowness 
of vessels, and a common space into which the 
veins from the gateway [of the liver] conduct 
the unpurified blood, and from which, in the 
first place, the [biliary] passages take over the 
bile, and secondly, the [branches] of the vena 
cava take over the purified blood. For it would 
not only have done him no harm to have men- 
tioned the idea of attraction, but he would there- 
by have been able to get rid of countless other 
disputed questions. 

5. At the actual moment, however, the Erasi- 
strateans are engaged in a considerable battle, 
not only with others but also amongst them- 
selves, and so they cannot explain the passage 
from the first book of the "General Principles," 
in which Erasistratus says, "Since there are two 
kinds of vessels opening at the same place, the 
one kind extending to the gall-bladder and the 
other to the vena cava, the result is that, of the 
nutriment carried up from the alimentary canal, 
that part which fits both kinds of stomata is re- 
ceived into both kinds of vessels, some being 
carried into the gall-bladder, and the rest pass- 
ing over into the vena cava." For it is difficult to 
say what we are to understand by the words 
"opening at the same place" which are written 
at the beginning of this passage. Either they 
mean there is a junction between the termina- 
tion of the vein which is on the concave surface 
of the liver and two other vascular terminations 
(that of the vessel on the convex surface of the 
liver and that of the bile-duct), or, if not, then 
we must suppose that there is, as it were, a com- 
mon space for all three vessels, which becomes 
filled from the lower vein,* and empties itself 
both into the bile-duct and into the branches of 
the vena cava. Now, there are many difficulties 
in both of these explanations, but if I were to 
state them all, I should find myself inadvertent- 

* The portal vein. 



ly writing an exposition of the teaching of Er- 
asistratus, instead of carrying out my original 
undertaking. There is, however, one difficulty 
common to both these explanations, namely, 
that the whole of the blood does not become 
purified. For it ought to fall into the bile-duct 
as into a kind of sieve, instead of going (run- 
ning, in fact, rapidly) past it, into the larger 
stoma, by virtue of the impulse of anadosis. 

Are these, then, the only inevitable difficul- 
ties in which the argument of Erasistratus be- 
comes involved through his disinclination to 
make any use of the attractive faculty, or is it 
that the difficulty is greatest here, and also so 
obvious that even a child could not avoid seeing 
it? 

6. And if one looks carefully into the matter 
one will find that even Erasistratus' reasoning 
on the subject of nutrition, which he takes up in 
the second book of his "General Principles," 
fails to escape this same difficulty. For, having 
conceded one premise to the principle that mat- 
ter tends to fill a vacuum, as we previously 
showed, he was only able to draw a conclusion 
in the case of the veins and their contained 
blood. That is to say, when blood is running 
away through the stornata of the veins, and is 
being dispersed, then, since an absolutely emp- 
ty space cannot result, and the veins cannot col- 
lapse (for this was what he overlooked), it was 
therefore shown to be necessary that the ad- 
joining quantum of fluid should flow in and fill 
the place of the fluid evacuated. It is in this way 
that we may suppose the veins to be nourished; 
they get the benefit of the blood which they con- 
tain. But how about the nerves? For they do 
not also contain blood. One might obviously 
say that they draw their supply from the veins. 
But Erasistratus will not have it so. What fur- 
ther contrivance, then, does he suppose? He 
says that a nerve has within itself veins and ar- 
teries, like a rope woven by Nature out of three 
different strands. By means of this hypothesis 
he imagined that his theory would escape from 
the idea of attraction. For if the nerve contain 
within itself a blood-vessel it will no longer 
need the adventitious flow of other blood from 
the real vein lying adjacent; this fictitious vessel, 
perceptible only in theory, will suffice it for 
nourishment. 

But this, again, is succeeded by another sim- 
ilar difficulty. For this small vessel will nourish 
itself, but it will not be able to nourish this ad- 
jacent simple nerve or artery, unless these pos- 
sess some innate proclivity for attracting nutri- 
ment. For how could the nerve, being simple, 



On the Natural Faculties II, 4-6 



189 



attract its nourishment, as do the composite 
veins, by virtue of the tendency of a vacuum to 
become refilled? For, although according to Er- 
asistratus, it contains within itself a cavity of 
sorts, this is not occupied with blood, but with 
psychic pneuma, and we are required to imag- 
ine the nutriment introduced, not into this cav- 
ity, but into the vessel containing it, whether it 
needs merely to be nourished, or to grow as well. 
How, then, are we to imagine it introduced? 
For this simple vessel [i.e. nerve] is so small 
as are also the other two that if you prick it at 
any part with the finest needle you will tear the 
whole three of them at once. Thus there could 
never be in it a perceptible space entirely empty. 
And an emptied space which merely existed in 
theory could not compel the adjacent fluid to 
come and fill it. 

At this point, again, I should like Erasistra- 
tus himself to answer regarding this small ele- 
mentary nerve, whether it is actually one and 
definitely continuous, or whether it consists of 
many small bodies, such as those assumed by 
Epicurus, Leucippus, and Democntus. For I 
see that the Erasistrateans are at variance on 
this subject. Some of them consider it one and 
continuous, for otherwise, as they say, he would 
not have called it simple; and some venture to 
resolve it into yet other elementary bodies. But 
if it be one and continuous, then what is evac- 
uated from it in the so-called insensible trans- 
piration of the physicians will leave no empty 
space in it; otherwise it would not be one body 
but many, separated by empty spaces. But if it 
consists of many bodies, then we have "escaped 
by the back door," as the saying is, to Asclepi- 
ades, seeing that we have postulated certain in- 
harmonious elements. Once again, then, we 
must call Nature "inartistic"; for this necessa- 
rily follows the assumption of such elements. 

For this reason some of the Erasistrateans 
seem to me to have done very foolishly in reduc- 
ing the simple vessels to elements such as these. 
Yet it makes no difference to me, since the the- 
ory of both parties regarding nutrition will be 
shown to be absurd. For in these minute simple 
vessels constituting the large perceptible nerves, 
it is impossible, according to the theory of those 
who would keep the former continuous, that 
any "refilling of a vacuum" should take place, 
since no vacuum can occur in a continuum even 
if anything does run away; for the parts left 
come together (as is seen in the case of water) 
and again become one, taking up the whole 
space of that which previously separated them. 
Nor will any "refilling" occur if we accept the 



argument of the other Erasistrateans, since none 
of their elements need it. For this principle on- 
ly holds of things which arc perceptible, and 
not of those which exist merely in theory; this 
Erasistratus expressly acknowledges, for he 
states that it is not a vacuum such as this, in- 
terspersed in small portions among the cor- 
puscles, that his various treatises deal with, but 
a vacuum which is clear, perceptible, complete 
in itself, large in size, evident, or however else 
one cares to term it (for, what Erasistratus him- 
self says is, that "there cannot be a perceptible 
space which is entirely empty"; while I, for my 
part, being abundantly equipped with terms 
which are equally elucidatory, at least in rela- 
tion to the present topic of discussion, have add- 
ed them as well). 

Thus it seems tome better that we also should 
help the Erasistrateans with some contribution, 
since we are on the subject, and should advise 
those who reduce the vessel called primary and 
simple by Erasistratus into other elementary 
bodies to give up their opinion; for not only do 
they gain nothing by it, but they are also at var- 
iance with Erasistratus in this matter. That they 
gain nothing by it has been clearly demonstrat- 
ed; for this hypothesis could not escape the dif- 
ficulty regarding nutrition. And it also seems 
perfectly evident to me that this hypothesis is 
not in consonance with the view of Erasistra- 
tus, when it declares that what he calls simple 
and primary is composite, and when it destroys 
the principle of Nature's artistic skill. For, if 
we do not grant a certain unity of substance to 
these simple structures as well, and if we ar- 
rive eventually at inharmonious and indivisible 
elements, we shall most assuredly deprive Na- 
ture of her artistic skill, as do all the physicians 
and philosophers who start from this hypothe- 
sis. For, according to such a hypothesis, Nature 
does not precede, but is secondary to the parts 
of the animal. Now, it is not the province of 
what comes secondarily, but of what pre-exists, 
to shape and to construct. Thus we must neces- 
sarily suppose that the faculties of Nature, by 
which she shapes the animal, and makes it grow 
and receive nourishment, are present from the 
seed onwards; whereas none of these inharmo- 
nious and non-partite corpuscles contains with- 
in itself any formative, incremental, nutritive, 
or, in a word, any artistic power; it is, by hypoth- 
esis, unimpressionable and untransformable, 
whereas, as we have previously shown, none of 
the processes mentioned takes place without 
transformation, alteration, and complete inter- 
mixture. And, owing to this necessity, those 



190 



Galen 



who belong to these sects are unable to follow out 
the consequences of their supposed elements, 
and they are all therefore forced to declare Na- 
ture devoid of art. It is not from us, however, 
that the Erasistrateans should have learnt this, 
but from those very philosophers who lay most 
stress on a preliminary investigation into the 
elements of all existing things. 

Now, one can hardly be right in supposing 
that Erasistratus could reach such a pitch of 
foolishness as to be incapable of recognizing the 
logical consequences of this theory, and that, 
while assuming Nature to be artistically creative, 
he would at the same time break up substance 
into insensible, inharmonious, and untrans- 
formable elements. If, however, he will grant 
that there occurs in the elements a process of 
alteration and transformation, and that there 
exists in them unity and continuity, then that 
simple vessel of his (as he himself names it) 
will turn out to be single and uncompounded. 
And the simple vein will receive nourishment 
from itself, and the nerve and artery from the 
vein. How, and in what way? For, when we 
were at this point before, we drew attention to 
the disagreement among the Erasistrateans, and 
we showed that the nutrition of these simple 
vessels was impraticable according to the teach- 
ings of both parties, although we did not hesi- 
tate to adjudicate in their quarrel and to do 
Erasistratus the honour of placing him in the 
better sect. 

Let our argument, then, be transferred again 
to the doctrine which assumes this elementary 
nerve to be a single, simple, and entirely unified 
structure, and let us consider how it is to be 
nourished; for what is discovered here will at 
once be found to be common also to the school 
of Hippocrates. 

It seems to me that our enquiry can be most 
rigorously pursued in subjects who are suffer- 
ing from illness and have become very emaci- 
ated, since in these people all parts of the body 
are obviously atrophied and thin, and in need 
of additional substance and feeding-up; for the 
same reason the ordinary perceptible nerve, re- 
garding which we originally began this discus- 
sion, has become thin, and requires nourish- 
ment. Now, this contains within itself various 
parts, namely, a great many of these primary, 
invisible, minute nerves, a few simple arteries, 
and similarly also veins. Thus, all its elemen- 
tary nerves have themselves also obviously be- 
come emaciated; for, if they had not, neither 
would the nerve as a whole; and of course, in 
such a case, the whole nerve cannot require 



nourishment without each of these requiring 
it too. Now, if on the one hand they stand in 
need of feeding-up, and if on the other the prin- 
ciple of the refilling of a vacuum can give them 
no help both by reason of the difficulties pre- 
viously mentioned and the actual thinness, as I 
shall show we must then seek another cause 
for nutrition. 

How is it, then, that the tendency of a vac- 
uum to become refilled is unable to afford nour- 
ishment to one in such a condition? Because its 
rule is that only so much of the contiguous mat- 
ter should succeed as has flowed away. Now 
this is sufficient for nourishment in the case of 
those who are in good condition, for, in them, 
what is presented must be equal to what has 
flowed away. But in the case of those who are 
very emaciated and who need a great restora- 
tion of nutrition, unless what was presented 
were many times greater than what has been 
emptied out, they would never be able to regain 
their original habit. It is clear, therefore, that 
these parts will have to exert a greater amount 
of attraction, in so far as their requirements are 
greater. And I fail to understand how Erasis- 
tratus does not perceive that here again he is 
putting the cart before the horse. Because, in 
the case of the sick, there must be a large amount 
of presentation in order to feed them up, he ar- 
gues that the factor of "refilling" must play an 
equally large part. And how could much pres- 
entation take place if it were not preceded by 
an abundant delivery of nutriment? And if he 
calls the conveyance of food through the veins 
delivery, and its assumption by each of these 
simple and visible nerves and arteries not deliv- 
ery but distribution, as some people have thought 
fit to name it, and then ascribes conveyance 
through the veins to the principle of vacuum- 
refilling alone, let him explain to us the assump- 
tion of food by the hypothetical elements. For 
it has been shown that at least in relation to 
these there is no question of the refilling of a 
vacuum being in operation, and especially 
where the parts are very attenuated. It is worth 
while listening to what Erasistratus says about 
these cases in the second book of his "General 
Principles'*: "In the ultimate simple [vessels], 
which are thin and narrow, presentation takes 
place from the adjacent vessels, the nutriment 
being attracted through the sides of the vessels 
and deposited in the empty spaces left by the 
matter which has been carried away/* Now, in 
this statement firstly I admit and accept the 
words "through the sides." For, if the simple 
nerve were actually to take in the food through 



On the Natural Faculties II, 6-8 



191 



its mouth, it could not distribute it through its 
whole substance; for the mouth is dedicated to 
the psychic pncuma. It can, however, take it in 
through its sides from the adjacent simple vein. 
Secondly, I also accept in Erasistratus' state- 
ment the expression which precedes "through 
the sides." What does this say? "The nutriment 
being attracted through the sides of the vessels.*' 
Now I, too, agree that it is attracted, but it has 
been previously shown that this is not through 
the tendency of evacuated matter to be replaced. 

7. Let us, then, consider together how it is at- 
tracted. How else than in the way that iron is at- 
tracted by the lodestone, the latter having a fac- 
ulty attractive of this particular quality [exist- 
ing in iron]? But if the beginning of anadosis 
depends on the squeezing action of the stom- 
ach, and the whole movement thereafter on the 
peristalsis and propulsive action of the veins, as 
well as on the traction exerted by each of the 
parts which are undergoing nourishment, then 
we can abandon the principle of replacement of 
evacuated matter, as not being suitable for a 
man who assumes Nature to be a skilled artist; 
thus we shall also have avoided the contradic- 
tion of Asclepiades though we cannot refute it: 
for the disjunctive argument used for the pur- 
poses of demonstration is, in reality, disjunctive 
not of two but of three alternatives; now, if we 
treat the disjunction as a disjunction of two al- 
ternatives, one of the two propositions assumed 
in constructing our proof must be false; and if 
as a disjunctive of three alternatives, no conclu- 
sion will be arrived at. 

8. Now Erasistratus ought not to have been ig- 
norant of this if he had ever had anything to do 
with the Peripatetics even in a dream. Nor, 
similarly, should he have been unacquainted 
with the genesis of the humours, about which, 
not having even anything moderately plausible 
to say, he thinks to deceive us by the excuse that 
the consideration of such matters is not the 
least useful. Then, in Heaven's name, is it use- 
ful to know how food is digested in the stom- 
ach, but unnecessary to know how bile comes 
into existence in the veins? Are we to pay at- 
tention merely to the evacuation of this humour, 
and not to its genesis? As though it were not 
far better to prevent its excessive development 
from the beginning than to give ourselves all 
the trouble of expelling it! And it is a strange 
thing to be entirely unaware as to whether its 
genesis is to be looked on as taking place in the 
body, or whether it comes from without and is 
contained in the food. For, if it was right to 
raise this problem, why should we not make in- 



vestigations concerning the blood as well 
whether it takes its origin in the body, or is dis- 
tributed through the food as is maintained by 
those who postulate homceomeries? Assuredly 
it would be much more useful to investigate 
what kinds of food are suited, and what kinds 
unsuited, to the process of blood-production 
rather than to enquire into what articles of diet 
are easily mastered by the activity of the stom- 
ach, and what resist and contend with it. For 
the choice of the latter bears reference merely 
to digestion, while that of the former is of im- 
portance in regard to the generation of useful 
blood. For it is not equally important whether 
the aliment be imperfectly chylified in the 
stomach or whether it fail to be turned into use- 
ful blood. Why is Erasistratus not ashamed to 
distinguish all the various kinds of digestive 
failure and all the occasions which give rise to 
them, whilst in reference to the errors of blood- 
production he does not utter a single word nay, 
not a syllable? Now, there is certainly to be 
found in the veins both thick and thin blood; 
in some people it is redder, in others yellower, 
in some blacker, in others more of the nature of 
phlegm. And one who realizes that it may 
smell offensively not in one way only, but in a 
great many different respects (which cannot be 
put into words, although perfectly appreciable 
to the senses), would, I imagine, condemn in no 
measured terms the carelessness of Erasistratus 
in omitting a consideration so essential to the 
practice of our art. 

Thus it is clear what errors in regard to the 
subject of dropsies logically follow this careless- 
ness. For, does it not show the most extreme 
carelessness to suppose that the blood is prevent- 
ed from going forward in^o the liver owing to 
the narrowness of the passages, and that dropsy 
can never occur in any other way? For, to im- 
agine that dropsy is never caused by the spleen 
or any other part, but always by induration of 
the liver,* is the standpoint of a man whose in- 
telligence is perfectly torpid and who is quite 
out of touch with things that happen every day. 
For, not merely once or twice, but frequently, 
we have observed dropsy produced by chronic 
haemorrhoids which have been suppressed, or 
which, through immoderate bleeding, have giv- 
en the patient a severe chill; similarly, in wom- 
en, the complete disappearance of the monthly 
discharge, or an undue evacuation such as is 
caused by violent bleeding from the womb, of- 
ten provoke dropsy; and in some of them the so- 
called female flux ends in this disorder. I leave 

* Cirrhosis of the liver. 



192. 



Galen 



out of account the dropsy which begins in the 
flanks or in any other susceptible part; this clear- 
ly confutes Erasistratus' assumption, although 
not so obviously as does that kind of dropsy 
which is brought about by an excessive chilling 
of the whole constitution; this, which is the pri- 
mary reason for the occurrence of dropsy, re- 
sults from a failure of blood-production, very 
much like the diarrhoea which follows imper- 
fect digestion of food; certainly in this kind of 
dropsy neither the liver nor any other viscus be- 
comes indurated. 

The learned Erasistratus, however, overlooks 
nay, despises what neither Hippocrates, 
Diodes, Praxagoras, nor Philistion despised, nor 
indeed any of the best philosophers, whether 
Plato, Aristotle, or Theophrastus; he passes 
by whole functions as though it were but a tri- 
fling and casual department of medicine which 
he was neglecting, without deigning to argue 
whether or not these authorities are right in 
saying that the bodily parts of all animals are 
governed by the Warm, the Cold, the Dry and 
the Moist, the one pair being active and the oth- 
er passive, and that among these the Warm has 
most power in connection with all functions, 
but especially with the genesis of the humours. 
Now, one cannot be blamed for not agreeing 
with all these great men, nor for imagining that 
one knows more than they; but not to consider 
such distinguished teaching worthy either of 
contradiction or even mention shows an ex- 
traordinary arrogance. 

Now, Erasistratus is thoroughly small-mind- 
ed and petty to the last degree in all his disputa- 
tions when, for instance, in his treatise "On 
Digestion," he argues jealously with those who 
consider that this is a process of putrefaction of 
the food; and, in his work "On Anadosis," with 
those who think that the anadosis of blood 
through the veins results from the contiguity of 
the arteries; also, in his work "On Respiration," 
with those who maintain that the air is forced 
along by contraction. Nay, he did not even hes- 
itate to contradict those who maintain that the 
urine passes into the bladder in a vaporous state, 
as also those who say that imbibed fluids are 
carried into the lung. Thus he delights to choose 
always the most valueless doctrines, and to 
spend his time more and more in contradicting 
these; whereas on the subject of the origin of 
blood (which is in no way less important than 
the chylification of food in the stomach) he did 
not deign to dispute with any of the ancients, 
nor did he himself venture to bring forward 
any other opinion, despite the fact that at the 



beginning of his treatise on "General Princi- 
ples" he undertook to say how all the various 
natural functions take place, and through what 
parts of the animal! Now, is it possible that, 
when the faculty which naturally digests food 
is weak, the animal's digestion fails, whereas 
the faculty which turns the digested food into 
blood cannot suffer any kind of impairment? 
Are we to suppose this latter faculty alone to be 
as tough as steel and unaffected by circum- 
stances? Or is it that weakness of this faculty 
will result in something else than dropsy? The 
fact, therefore, that Erasistratus, in regard to 
other matters, did not hesitate to attack even 
the most trivial views, whilst in this case he nei- 
ther dared to contradict his predecessors nor to 
advance any new view of his own, proves plain- 
ly that he recognized the fallacy of his own way 
of thinking. 

For what could a man possibly say about 
blood who had no use for innate heat? What 
could he say about yellow or black bile, or 
phlegm? Well, of course, he might say that the 
bile could come directly from without, mingled 
with the food! Thus Erasistratus practically 
says so in the following words: "It is of no value 
in practical medicine to find out whether a fluid 
of this kind * arises from the elaboration of food 
in the stomach-region, or whether it reaches 
the body because it is mixed with the food taken 
in from outside." But my very good Sir, you 
most certainly maintain also that this humour 
has to be evacuated from the animal, and that it 
causes great pain if it be not evacuated. How, 
then, if you suppose that no good comes from 
the bile, do you venture to say that an investi- 
gation into its origin is of no value in medicine? 

Well, let us suppose that it is contained in 
the food, and not specifically secreted in the liv- 
er (for you hold these two things possible). In 
this case, it will certainly make a considerable 
difference whether the ingested food contains a 
minimum or a maximum of bile; for the one 
kind is harmless, whereas that containing a 
large quantity of bile, owing to the fact that it 
cannot be properly purified in the liver, will re- 
sult in the various affections particularly jaun- 
dice which Erasistratus himself states to oc- 
cur where there is much bile. Surely, then, it is 
most essential for the physician to know in the 
first place, that the bile is contained in the food 
itself from outside, and, secondly, that for ex- 
ample, beet contains a great deal of bile, and 
bread very little, while olive oil contains most, 
and wine least of all, and all the other articles 

* Bile. 



On the Natural Faculties II, 8 



of diet different quantities. Would it not be ab- 
surd for any one to choose voluntarily those ar- 
ticles which contain more bile, rather than those 
contain ing less? 

What, however, if the bile is not contained in 
the food, but comes into existence in the ani- 
mal's body? Will it not also be useful to know 
what state of the body is followed by a greater, 
and what by a smaller occurrence of bile? For 
obviously it is in our power to alter and trans- 
mute morbid states of the body in fact, to give 
them a turn for the better. But if we did not 
know in what respect they were morbid or in 
what way they diverged from the normal, how 
should we be able to ameliorate them? 

Therefore it is not useless in treatment, as Er- 
asistratus says, to know the actual truth about 
the genesis of bile. Certainly it is not impossible, 
or even difficult to discover that the reason why 
honey produces yellow bile is not that it con- 
tains a large quantity of this within itself, but 
because it [the honey] undergoes change, be- 
coming altered and transmuted into bile. For 
it would be bitter to the taste if it contained bile 
from the outset, and it would produce an equal 
quantity of bile in every person who took it. 
The facts, however, are not so. For in those who 
are in the prime of life, especially if they are 
warm by nature and are leading a life of toil, 
the honey changes entirely into yellow bile. Old 
people, however, it suits well enough, inasmuch 
as the alteration which it undergoes is not into 
bile, but into blood. Erasistratus, however, in 
addition to knowing nothing about this, shows 
no intelligence even in the division of his ar- 
gument; he says that it is of no practical impor- 
tance to investigate whether the bile is contained 
in the food from the beginning or comes into 
existence as a result of gastric digestion. He 
ought surely to have added something about its 
genesis in liver and veins, seeing that the old 
physicians and philosophers declare that it a- 
long with the blood is generated in these organs. 
But it is inevitable that people who, from the 
very outset, go astray, and wander from the right 
road, should talk such nonsense, and should, 
over and above this, neglect to search for the 
factors of most practical importance in medicine. 

Having come to this point in the argument, 
I should like to ask those who declare that Era- 
sistratus was very familiar with the Peripatetics, 
whether they know what Aristotle stated and 
demonstrated with regard to our bodies being 
compounded out of the Warm, the Cold, the 
Dry and the Moist, and how he says that among 
these the Warm is the most active, and that 



those animals which are by nature warmest have 
abundance of blood, whilst those that are colder 
are entirely lacking in blood, and consequently 
in winter lie idle and motionless, lurking in 
holes like corpses. Further, the question of the 
colour of the blood has been dealt with not only 
by Aristotle but also by Plato. Now I, for my 
part, as I have already said, did not set before 
myself the task of stating what has been so well 
demonstrated by the Ancients, since I cannot 
surpass these men either in my views or in my 
method of giving them expression. Doctrines, 
however, which they either stated without dem- 
onstration, as being self-evident (since they 
never suspected that there could be sophists so 
degraded as to contemn the truth in these mat- 
ters), or else which they actually omitted to 
mention at all these I propose to discover and 
prove. 

Now in reference to the genesis of the hu- 
mours, I do not know that any one could add 
anything wiser than what has been said by Hip- 
pocrates, Aristotle, Praxagoras, Philotimus and 
many other among the Ancients. These men 
demonstrated that when the nutriment becomes 
altered in the veins by the innate heat, blood is 
produced when it is in moderation, and the oth- 
er humours when it is not in proper proportion. 
And all the observed facts agree with this argu- 
ment. Thus, those articles of food, which are 
by nature warmer are more productive of bile, 
while those which are colder produce more 
phlegm. Similarly of the periods of life, those 
which are naturally warmer tend more to bile, 
and the colder more to phlegm. Of occupations 
also, localities and seasons, and, above all, of 
natures themselves, the colder are more phleg- 
matic, and the warmer more bilious. Also cold 
diseases result from phlegm, and warmer ones 
from yellow bile. There is not a single thing to 
be found which does not bear witness to the 
truth of this account. How could it be other- 
wise? For, seeing that every part functions in 
its own special way because of the manner in 
which the four qualities are compounded, it is 
absolutely necessary that the function [activity] 
should be either completely destroyed, or, at 
least hampered, by any damage to the qualities, 
and that thus the animal should fall ill, either 
as a whole, or in certain of its parts. 

Also the diseases which are primary and most 
generic are four in number, and differ from each 
other in warmth, cold, dryness and moisture. 
Now, Erasistratus himself confesses this, albeit 
unintentionally; for when he says that the di- 
gestion of food becomes worse in fever, not be- 



Galen 



cause the innate heat has ceased to be in due 
proportion, as people previously supposed, but 
because the stomach, with its activity impaired, 
cannot contract and triturate as before then, 
I say, one may justly ask him what it is that 
has impaired the activity of the stomach. 

Thus, for example, when a bubo develops fol- 
lowing an accidental wound gastric digestion 
does not become impaired until after the patient 
has become fevered; neither the bubo nor the 
sore of itself impedes in any way or damages 
the activity of the stomach. But if fever occurs, 
the digestion at once deteriorates, and we are 
also right in saying that the activity of the stom- 
ach at once becomes impaired. We must add, 
however, by what it has been impaired. For the 
wound was not capable of impairing it, nor yet 
the bubo, for, if they had been, then they would 
have caused this damage before the fever as 
well. If it was not these that caused it, then it 
was the excess of heat (for these two symptoms 
occurred besides the bubo an alteration in the 
arterial and cardiac movements and an exces- 
sive development of natural heat). Now the al- 
teration of these movements will not merely not 
impair the function of the stomach in any way: 
it will actually prove an additional help among 
those animals in which, according to Erasistra- 
tus,the pneuma, which is propelled through the 
arteries and into the alimentary canal, is of great 
service in digestion; there is only left, then, the 
disproportionate heat to account for the dam- 
age to the gastric activity. For the pneuma is 
driven in more vigorously and continuously, and 
in greater quantity now than before; thus in 
this case, the animal whose digestion is pro- 
moted by pneuma will digest more, whereas the 
remaining factor abnormal heat will give 
them indigestion. For to say, on the one hand, 
that the pneuma has a certain property by vir- 
tue of which it promotes digestion, and then to 
say that this property disappears in cases of fe- 
ver, is simply to admit the absurdity. For when 
they are again asked what it is that has altered 
the pneuma, they will only be able to reply, "the 
abnormal heat," and particularly if it be the 
pneuma in the food canal which is in question 
(since this does not come in any way near the 
bubo). 

Yet why do I mention those animals in which 
the property of the pneuma plays an important 
part, when it is possible to base one's argument 
upon human beings, in whom it is either of no 
importance at all, or acts quite faintly and fee- 
bly? But Erasistratus himself agrees that hu- 
man beings digest badly in fevers, adding as 



the cause that the activity of the stomach has 
been impaired. He cannot, however, advance 
any other cause of this impairment than ab- 
normal heat. But if it is not by accident that the 
abnormal heat impairs this activity, but by vir- 
tue of its own essence and power, then this ab- 
normal heat must belong to the primary dis- 
eases. But, indeed, if disproportion of heat be- 
longs to the primary diseases, it cannot but be 
that a proportionate blending [eucrasia] of the 
qualities produces the normal activity. For a 
disproportionate blend [dyscrasia] can only be- 
come a cause of the primary diseases through 
derangement of the eucrasia. That is to say, it 
is because the [normal] activities arise from the 
eucrasia that the primary impairments of these 
activities necessarily arise from its derangement. 

I think, then, it has been proved to the satis- 
faction of those people who are capable of see- 
ing logical consequences, that, even according 
to Erasistratus* own argument, the cause of the 
normal functions is eucrasia of the Warm. Now, 
this being so, there is nothing further to pre- 
vent us from saying that, in the case of each 
function, eucrasia is followed by the more, and 
dyscrasia by the less favourable alternative. And, 
therefore, if this be the case, we must suppose 
blood to be the outcome of proportionate, and 
yellow bile of disproportionate heat. So we nat- 
urally find yellow bile appearing in greatest 
quantity in ourselves at the warm periods of 
life, in warm countries, at warm seasons of the 
year, and when we are in a warm condition; 
similarly in people of warm temperaments, and 
in connection with warm occupations, modes 
of life, or diseases. 

And to be in doubt as to whether this humour 
has its genesis in the human body or is contained 
in the food is what you would expect from one 
who has I will not say failed to see that, when 
those who are perfectly healthy have, under the 
compulsion of circumstances, to fast contrary to 
custom, their mouths become bitter and their u- 
rine bile-coloured, while they suffer from gnaw- 
ing pains in the stomach but has, as it were, 
just made a sudden entrance into the world, 
and is not yet familiar with the phenomena 
which occur there. Who, in fact, does not know 
that anything which is overcooked grows at first 
salt and afterwards bitter? And if you will boil 
honey itself, far the sweetest of all things, you 
can demonstrate that even this becomes quite 
bitter. For what may occur as a result of boil- 
ing in the case of other articles which arc not 
warm by nature, exists naturally in honey; for 
this reason it does not become sweeter on being 



On the Natural Faculties II, 8-9 



boiled, since exactly the same quantity of heat 
as is needed for the production of sweetness 
exists from beforehand in the honey. Therefore 
the external heat, which would be useful for 
insufficiently warm substances, becomes in the 
honey a source of damage, in fact an excess; 
and it is for this reason that honey, when boiled, 
can be demonstrated to become bitter sooner 
than the others. For the same reason it is easily 
transmuted into bile in those people who are 
naturally warm, or in their prime, since warm 
when associated with warm becomes readily 
changed into a disproportionate combination 
and turns into bile sooner than into blood. Thus 
we need a cold temperament and a cold period 
of life if we would have honey brought to the 
nature of blood. Therefore Hippocrates not im- 
properly advised those who were naturally bil- 
ious not to take honey, since they were obvious- 
ly of too warm a temperament. So also, not on- 
ly Hippocrates, but all physicians say that hon- 
ey is bad in bilious diseases but good in old age; 
some of them having discovered this through 
the indications afforded by its nature, and others 
simply through experiment, for the Empiricist 
physicians too have made precisely the same 
observation, namely, that honey is good for an 
old man and not for a young one, that it is 
harmful for those who are naturally bilious, and 
serviceable for those who are phlegmatic. In a 
word, in bodies which are warm either through 
nature, disease, time of life, season of the year, 
locality, or occupation, honey is productive of 
bile, whereas in opposite circumstances it pro- 
duces blood. 

But surely it is impossible that the same arti- 
cle of diet can produce in certain persons bile 
and in others blood, if it be not that the genesis 
of these humours is accomplished in the body. 
For if all articles of food contained bile from 
the beginning and of themselves, and did not 
produce it by undergoing change in the animal 
body, then they would produce it similarly in 
all bodies; the food which was bitter to the taste 
would, I take it, be productive of bile, while that 
which tasted good and sweet would not gener- 
ate even the smallest quantity of bile. Moreover, 
not only honey but all other sweet substances 
are readily converted into bile in the aforesaid 
bodies which are warm for any of the reasons 
mentioned. 

Well, I have somehow or other been led into 
this discussion, not in accordance with my 
plan, but compelled by the course of the argu- 
ment. This subject has been treated at great 
length by Aristotle and Praxagoras, who have 



correctly expounded the view of Hippocrates 
and Plato. 

9. For this reason the things that we have said 
are not to be looked upon as proofs but rather 
as indications of the dulness of those who think 
differently, and who do not even recognise what 
is agreed on by everyone and is a matter of daily 
observation. As for the scientific proofs of all 
this, they are to be drawn from these principles 
of which I have already spoken namely, that 
bodies act upon and are acted upon by each oth- 
er in virtue of the Warm, Cold, Moist and Dry. 
And if one is speaking of any activity, whether 
it be exercised by vein, liver, arteries, heart, ali- 
mentary canal, or any part, one will be inevita- 
bly compelled to acknowledge that this activi- 
ty depends upon the way in which the four 
qualities are blended. Thus I should like to ask 
the Erasistrateans why it is that the stomach 
contracts upon the food, and why the veins gen- 
erate blood. There is no use in recognizing the 
mere fact of contraction, without also knowing 
the cause; if we know this, we shall also be able 
to rectify the failures of function. "This is no 
concern of ours," they say; "we do not occupy 
ourselves with such causes as these; they are 
outside the sphere of the practitioner, and be- 
long to that of the scientific investigator." Are 
you, then, going to oppose those who maintain 
that the cause of the function of every organ is 
a natural eucrasia, that the dyscrasia is itself 
known as a disease, and that it is certainly by 
this that the activity becomes impaired? Or, on 
the other hand, will you be convinced by the 
proofs which the ancient writers furnished? Or 
will you take a midway course between these 
two, neither perforce accepting these arguments 
as true nor contradicting them as false, but sud- 
denly becoming sceptics Pyrrhonists, in fact? 
But if you do this you will have to shelter your- 
selves behind the Empiricist teaching. For how 
are you going to be successful in treatment, if 
you do not understand the real essence of each 
disease? Why, then, did you not call yourselves 
Empiricists from the beginning? Why do you 
confuse us by announcing that you are investi- 
gating natural activities with a view to treat- 
ment? If the stomach is, in a particular case, 
unable to exercise its peristaltic and grinding 
functions, how are we going to bring it back 
to the normal if we do not know the cause of 
its disability? What I say is that we must cool 
the over-heated stomach and warm the chilled 
one; so also we must moisten the one which 
has become dried up, and conversely; so, too, in 
combinations of these conditions; if the stom- 



196 Galen 

ach becomes at the same time warmer and drier 
than normally, the first principle of treatment 
is at once to chill and moisten it; and if it be- 
come colder and moister, it must be warmed 
and dried; so also in other cases. But how on 
earth are the followers of Erasistratus going to 
act, confessing as they do that they make no 
sort of investigation into the cause of disease? 
For the fruit of the enquiry into activities is that 
by knowing the causes of the dyscrasiae one may 
bring them back to the normal, since it is of no 
use for the purposes of treatment merely to know 
what the activity of each organ is. 

Now, it seems to me that Erasistratus is un- 
aware of this fact also, that the actual disease is 
that condition of the body which, not acciden- 
tally, but primarily and of itself, impairs the 
normal function. How, then, is he going to di- 
agnose or cure diseases if he is entirely igno- 
rant of what they are, and of what kind and 
number? As regards the stomach, certainly, 
Erasistratus held that one should at least inves- 
tigate how it digests the food. But why was not 
investigation also made as to the primary origi- 
native cause of this? And, as regards the veins 
and the blood, he omitted even to ask the ques- 
tion "how?" 

Yet neither Hippocrates nor any of the other 
physicians or philosophers whom I mentioned 
a short while ago thought it right to omit this; 
they say that when the heat which exists nat- 
urally in every animal is well blended and mod- 
erately moist it generates blood; for this reason 
they also say that the blood is a virtually warm 
and moist humour, and similarly also that yel- 
low bile is warm and dry, even though for the 
most part it appears moist. (For in them the 
apparently dry would seem to differ from the 
virtually dry.) Who does not know that brine 
and sea-water preserve meat and keep it uncor- 
rupted, whilst all other water the drinkable 
kind readily spoils and rots it? And who does 
not know that when yellow bile is contained in 
large quantity in the stomach, we are troubled 
with an unquenchable thirst, and that when 
we vomit this up, we at once become much 
freer from thirst than if we had drunk very large 
quantities of fluid? Therefore this humour has 
been very properly termed warm, and also virtu- 
ally dry. And, similarly, phlegm has been called 
cold and moist; for about this also clear proofs 
have been given by Hippocrates and the other 
Ancients. 

Prodicus also, when in his book "On the Na- 
ture of Man" he gives the name "phlegm" (from 
the verb TTC^AC'X&U) to that element in the hu- 



mours which has been burned or, as it were, 
over-roasted, while using a different terminol- 
ogy, still keeps to the fact just as the others do, 
this man's innovations in nomenclature have 
also been amply done justice to by Plato. Thus, 
the white-coloured substance which everyone 
else calls phlegm, and which Prodicus calls blen- 
na [mucus], is the well-known cold, moist hu- 
mour which collects mostly in old people and 
in those who have been chilled in some way, 
and not even a lunatic could say that this was 
anything else than cold and moist. 

If, then, there is a warm and moist humour, 
and another which is warm and dry, and yet an- 
other which is moist and cold, is there none 
which is virtually cold and dry? Is the fourth 
combination of temperaments, which exists in 
all other things, non-existent in the humours a- 
lone? No; the black bile is such a humour. This, 
according to intelligent physicians and philos- 
ophers, tends to be in excess, as regards seasons, 
mainly in the fall of the year, and, as regards 
ages, mainly after the prime of life. And, simi- 
larly, also they say that there are cold and dry 
modes of life, regions, constitutions, and dis- 
eases. Nature, they suppose, is not defective in 
this single combination; like the three other 
combinations, it extends everywhere. 

At this point, also, I would gladly have been 
able to ask Erasistratus whether his "artistic" 
Nature has not constructed any organ for clear- 
ing away a humour such as this. For whilst 
there are two organs for the excretion of urine, 
and another of considerable size for that of yel- 
low bile, does the humour which is more per- 
nicious than these wander about persistently 
in the veins mingled with the blood? Yet Hip- 
pocrates says, "Dysentery is a fatal condition if 
it proceeds from black bile"; while that proceed- 
ing from yellow bile is by no means deadly, and 
most people recover from it; this proves how 
much more pernicious and acrid in its potenti- 
alities is black than yellow bile. Has Erasistra- 
tus, then, not read the book, "On the Nature of 
Man," any more than any of the rest of Hip- 
pocrates' writings, that he so carelessly passes 
over the consideration of the humours? Or, does 
he